A novel treatment approach to the novel coronavirus: an argument for the use of therapeutic plasma exchange for fulminant COVID-19

• Published in: Critical care (London, England) Vol. 24; no. 1; p. 128
• Main Authors: Keith, Philip, Day, Matthew, Perkins, Linda, Moyer, Lou, Hewitt, Kristi, Wells, Adam
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02-04-2020; BioMed Central; BMC
• Subjects: Apheresis; Betacoronavirus; Biomarkers - blood; Care and treatment; Coronavirus Infections - diagnosis; Coronavirus Infections - therapy; Coronaviruses; COVID-19; COVID-19 Serotherapy; Critical care; Health aspects; Humans; Immunization, Passive; Investigations; Mortality; Pandemics - prevention & control; Plasma exchange (Therapeutics); Plasma Exchange - methods; Pneumonia, Viral - diagnosis; Pneumonia, Viral - therapy; Respiration, Artificial; SARS-CoV-2; Severe Acute Respiratory Syndrome; United Kingdom; United States > US; China
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-020-2836-4

When fulminant, patients may develop sepsis, acute respiratory distress syndrome (ARDS), and/or multiple organ failure which are not unique to coronavirus. The pathway is common to multiple inciting events and has been the target of treatment for years, with therapeutic plasma exchange uniquely offering benefit on multiple levels by removing inflammatory cytokines, stabilizing endothelial membranes, and resetting the hypercoagulable state [4, 8, 9]. SEE PDF] Busund and colleagues showed a tendency toward improved mortality with adjunct TPE in adult patients with sepsis and multiple organ failure in the sole, adult-only randomized controlled trial on this subject [10] while a meta-analysis by Rimmer showed mortality benefit in adult patients as well [11].