COVID-19 & CytoSorb Therapie
Initial reports suggest that COVID-19 is associated with severe disease, that requires intensive care in approximately 5% of proven infections. The virus can result in a dysregulated immune response and this cytokine storm seems to be associated with disease severity, as it can lead to capillary leak syndrome, progressive lung injury, respiratory failure and acute respiratory distress syndrome (ARDS).
In addition to ARDS, further complications in the critically ill include shock, acute cardiac injury and AKI. This is in line with what is known from other viral infections like influenza and previous coronavirus infections (SARS, MERS), as well as with the general fact that infectious and non-infectious triggers can result in a cytokine storm, progressing to vasoplegic shock and finally multi organ dysfunction syndrome.
Rationale of using CytoSorb Therapy in critically ill COVID-19 patients
CytoSorb is a European Union-approved extracorporeal cytokine adsorber, designed to broadly reduce cytokine storm and other inflammatory mediators in the blood that could otherwise lead to uncontrolled systemic inflammation, organ failure, and death in many life-threatening illnesses. CytoSorb has been used safely in more than 80,000 treatments worldwide, primarily in the treatment of systemic hyperinflammation in a wide variety of life-threatening conditions.
Experience in Treating Patients with COVID-19 infection
The rationale of using blood purification to treat cytokine storm in critically-ill COVID-19 patients was recently detailed by a recent publication that concluded, “Finally, a sepsis-like syndrome might occur frequently due to the virus itself or to a superimposed bacterial infection and in this case, since pharmacological approaches have shown poor results, new extracorporeal organ support therapies including hemoadsorption and hemoperfusion, with new sorbent cartridges designed to remove cytokines and other circulating mediators, should be considered.” (1)
To date, more than 65 critically ill patients with COVID-19 infection have been treated with CytoSorb in various centers in Italy, China and Germany. Although patient level data is not yet available due to the extraordinary circumstances in these countries, the positive results in Italy have led to the formal recommendation by the Italy Brescia Renal COVID Task Force and published by the Italian Society of Nephrology and ERA-EDTA, to specifically use CytoSorb in severe COVID-19 patients with Stage 3 AKI receiving Continuous Renal Replacement Therapy (CRRT). (2) Also, the recent National Guidelines on adult COVID-19 patients from Panama recommend CytoSorb Therapy. (3) In addition, the recent Handbook of COVID-19 Prevention and Treatment from Zhejiang University School of Medicine, China, is also recommending blood purification to treat cytokine storm in critical cases of COVID-19 infection. (4)
Rationale für den Einsatz
Informationen zu COVID-19 und CytoSorb Therapie
Kodierung von COVID-19 Patienten
Die WHO hat vorübergehend einen Diagnoseschlüssel für Patienten mit COVID-19 belegt: ICD U07.1. Für die ICD-10-WHO wird der Kode als Primärcode umgesetzt: U07.1 COVID-19.
Für die ICD-10-GM (German Modification) wird der Kode als sekundärer Kode (Ausrufezeichenschlüsselnummer) angelegt:
U07.1! COVID-19 (Coronavirus-Krankheit-2019)
Der Schlüssel soll umgehend für die Kodierung entsprechender Fälle angewendet werden.
Behandlungsrichtlinien & Links
COVID-19-Behandlungsrichtlinien, die die CytoSorb-Therapie empfehlen
Links zu sicheren Quellen
CytoSorb Therapie bei COVID-19 Patienten
CytoSorb ist in den USA nicht kommerziell erhältlich.
- Ronco C, Navalesi P, Vincent JL. Coronavirus epidemic: preparing for extracorporeal organ support in intensive care. Lancet Resp Med 2020;8(3):240-241.
- Brescia Renal Covid Task Force : Alberici F et al., GESTIONE DEL PAZIENTE IN DIALISI E CON TRAPIANTO DI RENE IN CORSO DI INFEZIONE DA CORONAVIRUS COVID-19, published March 18th by the Italian Society of Nephrology and by ERA-EDTA
- Asociación Panameña de Medicina Critica y Terapia Intensiva, GUÍAS NACIONALES DE ATENCIÓN DE PACIENTES ADULTOS COVID-19 VERSION 2.0, published on March 22nd
- Liang T (editor-in-Chief). Handbook of COVID-19 Prevention and Treatment, The First Affiliated Hospital, Zhejiang University School of Medicine, Compiled According to Clinical Experience.