ABSTRACT
Objective: COVID-19 caused many deaths through a dysregulated immune response contributing to multiorgan failure [1]. Patients with severe respiratory failure have required ECMO as a rescue therapy [2]. The oXiris adsorptive haemofilter has the capacity to adsorb cytokines while delivering continuous renal replacement therapy (CRRT) [3]. Therefore, patients with multi-organ failure secondary to COVID-19 could be managed with ECMO and haemoadsorptive therapy as a novel approach [4]. Minimal evidence currently exists of its effectiveness or safety. Our Objective therefore is to evaluate the safety and efficacy of oXiris in COVID-19 patients on VV-ECMO with AKI. Methods: A single-site prospective observational case series was conducted from March to June 2020. Inclusion criteria were: COVID-19, age >18, VV-ECMO, CRRT and severe septic shock. Data was collected at baseline and over three successive oXiris filters. Data included vasopressor requirements, biochemical markers and vital signs. Variables at baseline and completion of therapy were compared using Wilcoxon Signed Ranks Test, two-tailed p-values (significance p< 0.05). Results: Eight patients were included;7 males and 1 female with a mean age of forty-seven. None had preexisting renal disease and mean baseline creatinine on admission was 230 umol/L. Mean CRP was 252 mg/dL with a mean lactate of 3.12 mmol/L. The median vasopressin dose fell significantly from 0.02 units/min to 0.00 units/min (p = 0.031), median noradrenaline dose fell significantly from 0.23 mcg/kg/ min to 0.06 mcg/kg/min (p = 0.039) and median urine output significantly improved from 0 ml/day to 151 ml/day (p = 0.008). There were no adverse events reported. Conclusions: The use of oXiris adsorbent membrane in patients requiring VV-ECMO for COVID-19 with clinical evidence of a cytokine storm was safe, with no adverse events. There was also significant improvement of haemodynamic stability and initial renal recovery. Further evaluation through a large randomised control trial is warranted.