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Effect of extracorporeal hemoadsorption in critically ill patients with COVID-19: A narrative review
Kaixi Chang1, Yupei Li1, Zheng Qin1
1Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China.
Insights
Extracorporeal hemoadsorption may aid critically ill COVID-19 patients by managing immune responses and viral load. Further research is needed to clarify optimal use and survival benefits of this treatment.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Nephrology
Background:
- COVID-19 presents complex challenges, including cytokine storm and organ dysfunction, leading to high mortality.
- New variants and elusive pathophysiology necessitate advanced treatment strategies.
- Extracorporeal hemoadsorption is emerging as a potential adjuvant therapy for severe COVID-19.
Purpose of the Study:
- To review the scientific rationale for using hemoadsorption in critically ill COVID-19 patients.
- To synthesize current clinical evidence on hemoadsorption for COVID-19 management.
Main Methods:
- This is a narrative review.
- Comprehensive literature search was performed to gather relevant studies and data.
Main Results:
- Hemoadsorption demonstrates potential in regulating immune homeostasis, reducing viremia, and decreasing endotoxin activity.
- Evidence suggests hemoadsorption can be an effective adjuvant to standard care in critically ill COVID-19 patients.
Conclusions:
- Hemoadsorption offers a promising adjunctive approach for managing critically ill COVID-19 patients.
- Key areas requiring further investigation include hemofilter selection, therapy timing, anticoagulation, and patient subgroup identification for optimal survival benefit.
Abstract:
COVID-19 has been affecting the world unprecedentedly and will remain widely prevalent due to its elusive pathophysiological mechanism and the continuous emergence of new variants. Critically ill patients with COVID-19 are commonly associated with cytokine storm, multiple organ dysfunction, and high mortality. To date, growing evidence has shown that extracorporeal hemoadsorption can exert its adjuvant effect to standard of care by regulating immune homeostasis, reducing viremia, and decreasing endotoxin activity in critically ill COVID-19 cases. However, the selection of various hemofilters, timing of initiation and termination of hemoadsorption therapy, anticoagulation management of extracorporeal circuits, identification of target subgroups, and ultimate survival benefit remain controversial. The purpose of this narrative review is to comprehensively summarize the rationale for the use of hemoadsorption in critically ill patients with COVID-19 and to gather the latest clinical evidence in this field.
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