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Introduction: Novel coronavirus disease 2019 (COVID-19) is a highly infectious, rapidly spreading viral disease, as of writing this article there are over 6.3million people are affected. The virus can result in a dysregulated immune response and cytokine storm which is associated with disease severity, leading to capillary leak syndrome, progressive lung injury, respiratory failure, and acute respiratory distress syndrome (ARDS). CytoSorb is a European Union-approved extracorporeal cytokine adsorber, designed to broadly reduce cytokine storm and other inflammatory mediators in the blood. On 10 April 2020, the US Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for emergency use of CytoSorb to treat patients 18 years of age or older with confirmed COVID-19 admitted to the ICU. In this case report, we discuss two COVID-19 positive patients who were admitted to the ICU with severe ARDS and were treated with VV ECMO and Cytosorb. Cytosorb has been extensively studied in patients with sepsis however the reports of treating patients with COVID-19 in cytokine storm are scanty hence this descriptive article will benefit the institutions who are planning on adopting this mode of therapy to treat COVID-19 patients Methods: We discuss COVID-19 positive patients who were admitted to the ICU with severe ARDS, AKI and were treated with VV ECMO, Cytosorb and CRRT. Cytosorb has been extensively studied in patients with sepsis however the reports of treating patients with COVID-19 in cytokine storm are scanty hence this descriptive article will benefit the institutions who are planning on adopting this mode of therapy to treat COVID-19 patients Results: In this case series we have described an improvement clinically in terms of reducing pressor and fio2 requirements which co-related well with the reduction of IL-6 levels however there were other confounding factors like administration of Tocilizumab and VV ECMO which could have contributed to the improvement of the patients. The patients are now dialysis dependent and became hemodynamically stable 3-4 weeks into their admission and were eventually extubated Conclusion(s): Cytokine adsorbing column in severe COVID-19 patients with Acute kidney injury does help in improvement of pressor and fio2 requirements which co-related well with the reduction of IL-6 levels in a short period of time. With other centers adapting Cytosorb we will eventually have better information about the overall outcome of these patients No conflict of interestCopyright © 2023
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The corona virus disease-19 (COVID-19) produced by SARS-CoV-2 has resulted in a wide spectrum of illness ranging from mild to life-threatening conditions thus enhancing the incidence of opportunistic infections among individuals harbouring comorbidities. Mucormycosis is a dreadful angio-invasive opportunistic infection produced by zygomycetes fungus in an immunocompromised host. The clinical manifestations of mucormycosis include rhino-orbital-cerebral (ROC), pulmonary, cutaneous, gastrointestinal, with ROC accounting for around 40% of cases. Diabetes, neutropenia, iron overload, cancer, and organ transplant are all major culprits. Both Aspergillus and Candida have been identified as the primary fungal pathogens causing co-infection in COVID-19 preyed individuals. The most predominant variety, Rhizopus Oryzae, is responsible for roughly 60% of mucormycosis infections in humans, as well as 90% of the Rhino-orbital-cerebral (ROCM) variant. Mucormycosis is the most widespread ailment in India. Until lately, India was declared to be the world's diabetes capital, with the second-largest number of people suffering from diabetes mellitus (DM). Diabetes has been recognised as the most common predictive marker for mucormycosis which explains the dramatic rise in Mucor cases in India lately particularly during second wave of COVID-19. The inflammatory onslaught caused by COVID 19 has debilitated patients' immune systems, making individuals vulnerable to mucormycosis outbreaks. The possible explanation that Mucorales spores appear to be expediting germination in people with COVID-19 is due to the perfect scenario of oxygen deprivation (hypoxia), hyperglycemia (steroid-induced), acidic form of media (metabolic acidosis, diabetic ketoacidosis), increased iron levels (elevated ferritin), and significantly reduced phagocytic activity of white blood cells (WBC) due to immunosuppression (SARS-CoV-2 or steroid mediated or associated comorbidities). Copyright © 2022 International Medical Sciences Academy. All rights reserved.