A Case of Cytokine Hemofiltration and Extracorporeal Life Support as Treatment of Coronavirus Disease 2019 (COVID-19) Respiratory Failure

Despite the critical role of cytokines in the modulation of the immune response, cytokine hyperactivity has been implicated in the pathogenesis of severe organ failure secondary to sepsis, cardiac surgery, immunotherapy, and a myriad of other disease states. Mitigation of inflammatory overactivity is a therapeutic option that has garnered much interest over the years. In addition to corticosteroids and immunoglobulins, cytokine hemofiltration can be another such option, helping to attenuate plasma levels of inflammatory markers.

As of this time, the exact pathogenesis of coronavirus disease 2019 (COVID-19) is unknown, but a hyperactive immune response has been implicated as a possible cause of the ensuing, overwhelming cytokine storm. Cytokine hemofiltration has been endorsed as a treatment therapy for patients with acute kidney injury requiring renal-replacement therapy in some COVID-19 epicenters. The fundamental difficulty remains in selecting patients with a hyperactive immune response and determining the optimal timing for therapy. Trending of inflammatory markers is one such stratification method, but given the low risk associated with hemofiltration, use in refractory hypoxemia should be considered.