Therapeutic plasma exchange: A potential therapeutic modality for critically ill adults with severe acute respiratory syndrome coronavirus 2 infection

Background: Severe acute respiratory syndrome coronavirus 2 infection can be severe and fatal due to cytokine storm. Therapeutic plasma exchange (TPE) potentially mitigates the harmful effects of such cytokines. We investigated the use of TPE, as rescue therapy, in patients with severe Coronavirus disease 2019 (COVID-19) infection. Study Design and Methods: A retrospective analysis on COVID-19 patients admitted to the intensive care unit and treated with TPE from April 17, 2020 to July 2, 2020. This group was compared with COVID-19 patients who received standard therapy without TPE. The following outcomes were analyzed: changes in laboratory parameters, length of hospital stay (LOS), days on mechanical ventilation, mortality at days 14 and overall mortality. Results: A total of 95 patients were included, among whom 47% (n = 45) received TPE. Patients who received TPE had reductions in C-reactive protein (P =.002), ferritin (P <.001) and interleukin-6 (P =.013). After employing entropy-balancing matching method, those on TPE were also more likely to discontinue inotropes (72% vs 21%; P <.001). However, they were more likely to be associated with longer LOS (23 vs 14 days; P =.002) and longer days on ventilatory support (14 vs 8 days; P <.001). Despite marginal mortality benefit at 14-days (7.9% vs 24%; P =.071), there was no significant differences in overall mortality (21% vs 31%; P =.315) between the groups. Conclusions: TPE was effective in reducing inflammatory markers in patients with severe COVID-19 infection, however, further research is warranted.