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Abstract: PO0161

Hemoperfusion with Seraph® Filter Late in the Course of Severe COVID-19 Pneumonia

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Ahmad, Yahya Rauf, University of Kentucky Medical Center, Lexington, Kentucky, United States
  • Neyra, Javier A., University of Kentucky Medical Center, Lexington, Kentucky, United States
  • Ayach, Taha, University of Kentucky Medical Center, Lexington, Kentucky, United States
Introduction

Severe COVID-19 infection is often associated with uncontrolled cytokine response and a milieu of circulating inflammatory markers. Cytokine adsorption with viral binding of SARS-CoV-2 has been utilized in severe COVID-19 cases under emergency use authorization by the FDA. Evolving observations of its use showed reduction in inflammatory markers; improvement in hemodynamics; reduction of vasopressor requirements and oxygen support; and avoidance or reduction of time on mechanical ventilation. We report a case of hemoperfusion utilizing the Seraph® filter as a last resource in a patient with life-threatening COVID-19 infection.

Case Description

A 37-year old female with a diagnosis of morbid obesity (BMI 60 kg/m2) presented to the University of Kentucky hospital with acute respiratory failure from COVID-19 pneumonia. The patient required ICU care, mechanical ventilation and eventually extracorporeal mechanical oxygenation (ECMO) on day 5 of her hospital stay. Despite aggressive COVID-19 management, her condition gradually worsened. On day 15 of her hospital stay, extracorporeal sorbent hemoperfusion via Seraph® filter was delivered through PrismaFlex® in tandem with the ECMO circuit. Her serum IL-6 levels dropped from 154 pg/ml to 29 pg/ml, and C-reactive protein from 317 mg/L to 294 mg/L within 2 hours of treatment completion. She had intermittent fevers up to 40C, especially in the 48 hours prior to treatment which resolved right away with hemoperfusion and she remained afebrile for the next 72 hours. There was, however, no significant change in her hemodynamics and overall clinical status and the patient remains on ECMO and mechanical ventilation at the time of this report (Day 34).

Discussion

This case exemplifies that hemoperfusion therapy delivered late in the course of severe COVID-19 disease is still effective in decreasing circulating inflammatory markers, but may not be effective in significantly and positively affecting clinical outcomes. Although circulating inflammatory markers could be used to guide eligibility for hemoperfusion therapy, timing of hemoperfusion should be considered in clinical trials to effectively test the potential of this intervention to ameliorate clinical outcomes in susceptible populations.