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Read a compelling article published a few days ago entitled: Haemoperfusion should only be used for COVID-19 in the context of randomized trials by @hswapnil @DrRonWald et al
https://www.nature.com/articles/s41581-020-00352-9
Some key points I wanted to highlight are found here. A thread/
https://www.nature.com/articles/s41581-020-00352-9Some key points I wanted to highlight are found here. A thread/
1/ Some background:
Patients with COVID19 may develop an overwhelming hyperinflammatory response =
cytokine storm
circulating pro-inflammatory cytokines ( IL-1β, IL-6, TNF)
worsening ARDS
While appropriate response may be good…
Exaggerated = BAD (MODS)
Patients with COVID19 may develop an overwhelming hyperinflammatory response =
cytokine storm circulating pro-inflammatory cytokines ( IL-1β, IL-6, TNF) worsening ARDS While appropriate response may be good…
Exaggerated = BAD (MODS)
2/ Why use hemoperfusion (HPF) for COVID-19?
It is thought to mitigate excessive inflammation by removing these proinflamm cytokines
How? Blood circulates through a sorbent-containing cartridge nonselectively adsorbing cytokines, endotoxins.
Sounds cool right?
It is thought to mitigate excessive inflammation by removing these proinflamm cytokines How? Blood circulates through a sorbent-containing cartridge nonselectively adsorbing cytokines, endotoxins. Sounds cool right?
3/ Unfortunately, RCT trials have found it ineffective in reducing mortality in patients with sepsis
Biggest one: EUPHRATES: https://jamanetwork.com/journals/jama/fullarticle/2706139
Consistent with failure of other CONVECTIVE KRT modalities to show benefit in mitigating inflammation
Biggest one: EUPHRATES: https://jamanetwork.com/journals/jama/fullarticle/2706139
Consistent with failure of other CONVECTIVE KRT modalities to show benefit in mitigating inflammation
4/ So far, HPF benefit: unclear
Risks:
removes beneficial substances (antibiotics, good cytokines)
infection
allergic reaction
hypotension, arrhythmia
Figure from the same article
Risks:
removes beneficial substances (antibiotics, good cytokines)infectionallergic reactionhypotension, arrhythmiaFigure from the same article
5/ In fact, those found to theoretically benefit from HPF are the same patients shown to benefit from dexamethasone
RECOVERY: https://doi.org/10.1056/NEJMoa2021436
Dexa:
less invasive
less expensive
more widely available
RECOVERY: https://doi.org/10.1056/NEJMoa2021436
Dexa:
less invasive less expensive more widely available
6/ To demonstrate that HPF is effective in severe COVID-19
must now show it can provide benefits via immunomodulation beyond what dexa can give
needs to be evaluated within the appropriate ethical and legal framework
must now show it can provide benefits via immunomodulation beyond what dexa can give needs to be evaluated within the appropriate ethical and legal framework
7/ Some other key takeaways:
use of uncontrolled interventions during the COVID-19 pandemic represents a missed learning opportunity
Current use of HPF for COVID-19 may be due to physicians’ perceived need to take action even if it could be futile or potentially harmful
use of uncontrolled interventions during the COVID-19 pandemic represents a missed learning opportunityCurrent use of HPF for COVID-19 may be due to physicians’ perceived need to take action even if it could be futile or potentially harmful
End/ some food for thought this weekend. 
Again check it out here: https://www.nature.com/articles/s41581-020-00352-9
Again check it out here: https://www.nature.com/articles/s41581-020-00352-9
