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Plasma Exchange: An Effective Rescue Therapy in Critically Ill Patients With Coronavirus Disease 2019 Infection

2020; Lippincott Williams & Wilkins; Volume: 48; Issue: 12 Linguagem: Inglês

10.1097/ccm.0000000000004613

1530-0293

Javier Fernández, Jordi Gratacós‐Ginès, Pol Olivas, Montserrat Costa, Susana Nieto, Dolors Mateo, María Belén Sánchez, Ferrán Aguilar, Octavi Bassegoda, Pablo Ruíz, Berta Caballol, Anna Pocurull, Joan Llach, María Jesús Mustieles, Joan Cid, Enric Reverter, David Toapanta, Maria De Santis, José Antonio Martínez, J. J. Clariá, Carlos Fernández, José Mensa, Vicente Arroyo, Pedro Castro, Miquel Lozano,

COVID-19 Impact on Reproduction

Infection by severe acute respiratory syndrome coronavirus-2 can induce uncontrolled systemic inflammation and multiple organ failure. The aim of this study was to evaluate if plasma exchange, through the removal of circulating mediators, can be used as rescue therapy in these patients.Single center case series.Local study.Four critically ill adults with coronavirus disease 19 pneumonia that failed conventional interventions.Plasma exchange. Two to six sessions (1.2 plasma volumes). Human albumin (5%) was used as the main replacement fluid. Fresh frozen plasma and immunoglobulins were administered after each session to avoid coagulopathy and hypogammaglobulinemia.Serum markers of inflammation and macrophage activation. All patients showed a dramatic reduction in inflammatory markers, including the main cytokines, and improved severity scores after plasma exchange. All survived to ICU admission.Plasma exchange mitigates cytokine storm, reverses organ failure, and could improve survival in critically ill patients with coronavirus disease 2019 infection.