Review Article

Review of the Potential of Hemoperfusion for the Treatment of Patients with Respiratory Infectious Diseases with COVID-19 Approach


Severe infection with COVID-19 disease can be associated with respiratory failure, kidney disorders, and in more advanced stages, organ failure and death. Unfortunately, there is currently no definitive cure for this disease, and damage to the immune system caused by inflammatory storms leads to widespread and varied complications that make an early diagnosis of the disease difficult. Therefore, eliminating or inhibiting the production of factors involved in inflammatory storms can be effective in improving the clinical condition of patients. According to specialized studies on the role of hemoperfusion in inhibiting advanced levels of COVID-19 disease, the present study was performed to investigate the use of hemoperfusion as a potential treatment option for this disease.

[1] Abedini A, Mirtajani SB, Karimzadeh M, Jahangirifard A, Kiani A. Can Hesperidin be the Key to the Treatment of Severe Acute Respiratory Syndrome COV-2?. Biomedical and Biotechnology Research Journal (BBRJ). 2020; 4(5):108.
[2] Yang X, Yu Y, Xu J, Shu H, Xia J, LiuH, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020; 8(5):475-81.
[3] Anand D, Ray S, Bhargava S, Das S, Garg A, Taneja S, et al. Proinflammatory versus anti-inflammatory response in sepsis patients: looking at the cytokines. Crit Care. 2014; 18(Suppl 2): P13.
[4] Barry S, Johnson M, Janossy G. Cytopathology or immunopathology? The puzzle of cytomegalovirus pneumonitis revisited. Bone Marrow Transplant. 2000; 26(6):591-7.
[5] Imashuku S. Clinical features and treatment strategies of Epstein–Barr virus-associated hemophagocytic lymphohistiocytosis. Crit Rev Oncol Hematol. 2002; 44(3):259-72.
[6] Bisno A, Brito M, Collins C. Molecular basis of group A streptococcal virulence. Lancet Infect Dis. 2003; 3(4):191-200.
[7] Yokota S. Influenza-associated encephalopathy– pathophysiology and disease mechanisms. Nihon Rinsho. 2003; 61(11):1953- 8.
[8] Jahrling PB, Hensley LE, Martinez MJ, LeDuc JW, Rubins KH, Relman DA, et al. Exploring the potential of variola virus infection of cynomolgus macaques as a model for human smallpox. Proc Natl Acad Sci U S A. 2004; 101(42):15196-200.
[9] Huang KJ, Su IJ, Theron M, Wu YC, Lai SK, Liu CC, et al. An interferon-Y-related cytokine storm in SARS patients. J Med Virol. 2005; 75(2):185-94.
[10] Pedersen SF, Ho YC. SARS-CoV-2: a storm is raging. J Clin Invest. 2020; 130(5):2202-2205.
[11] Lau SK, Lau CC, Chan K-H, Li CP, Chen H, Jin D-Y, et al. Delayed induction of proinflammatory cytokines and suppression of innate antiviral response by the novel Middle East respiratory syndrome coronavirus: implications for pathogenesis and treatment. J Gen Virol. 2013; 94(12):2679-90.
[12] Yuen KY, Wong SS. Human infection by avian influenza A H5N1. Hong Kong Med J. 2005; 11(3):189-99.
[13] Osterlund P, Pirhonen J, Ikonen N, Ronkko E, Strengell M, Makela SM, et al. Pandemic H1N1 2009 Influenza A Virus Induces Weak Cytokine Responses in Human Macrophages and Dendritic Cells and Is Highly Sensitive to the Antiviral Actions of Interferons. J Virol. 2010; 84(3):1414-22.
[14] PollardHB, Pollard BS, Pollard JR. Classical drug digitoxin inhibits influenza cytokine storm, with implications for COVID-19 therapy. In Vivo. 2020; 34(6):3723-3730.
[15] Gong J, Dong H, Xia SQ, Huang YZ, Wang D, Zhao Y, et al. Correlation analysis between disease severity and inflammation-related parameters in patients with COVID-19 pneumonia. MedRxiv. 2020.
[16] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus inWuhan, China. lancet. 2020; 395(10223):497-506.
[17] Ruan Q, Yang K, WangW, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020; 46(5):846-8.
[18] Stockman LJ, Bellamy R, Garner P. SARS: systematic review of treatment effects. PLoS Med. 2006; 3(9):e343.
[19] Falzarano D, De Wit E, Rasmussen AL, Feldmann F, Okumura A, Scott DP, et al. Treatment with interferon-®2b and ribavirin improves outcome in MERS-CoV–infected rhesusmacaques. Nat Med. 2013; 19(10):1313-7.
[20] Omrani AS, SaadMM, Baig K, Bahloul A, Abdul-MatinM, Alaidaroos AY, et al. Ribavirin and interferon alfa-2a for severeMiddle East respiratory syndrome coronavirus infection: a retrospective cohort study. Lancet Infect Dis. 2014; 14(11):1090-5.
[21] Ankawi G, Neri M, Zhang J, Breglia A, Ricci Z, Ronco C. Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls. Crit Care. 2018; 22(1):262.
[22] Goldfarb D, Matalon D. Principles and techniques applied to enhance elimination. Goldfrank’s toxicologic emergencies: McGraw-Hill, New York; 2006. p. 160-72.
[23] Locket S. Haemodialysis in the treatment of acute poisoning. Proc R Soc Med. 1970; 63(5): 427–430.
[24] Doolan PD, Walsh WP, Wishinsky H. Acetylsalicylic acid intoxication; a proposed method of treatment. J Am Med Assoc. 1951; 146(2):105-6.
[25] Fiore B, Soncini M, Vesentini S, Penati A, Visconti G, Redaelli A. Multi-scale analysis of the toraymyxin adsorption cartridge. Part II: computational fluid-dynamic study. Int J Artif Organs. 2006; 29(2):251-60.
[26] Vesentini S, Soncini M, Zaupa A, Silvestri V, Fiore GB, Redaelli A. Multi-scale analysis of the toraymyxin adsorption cartridge. Part I: molecular interaction of polymyxin B with endotoxins. Int J Artif Organs. 2006; 29(2):239-50.
[27] Ronco C, Piccinni P, Kellum J. Rationale of extracorporeal removal of endotoxin in sepsis: theory, timing and technique. Contrib Nephrol. 2010; 167:25-34.
[28] Navas A, Ferrer R, Martinez ML, Goma G, Gili G, Masip J, et al. Impact of hemoperfusion with polymyxin B added to hemofiltration in patients with endotoxic shock: a case-control study. Ann Intensive Care. 2018; 8(1):121.
[29] Muirhead EE, Reid AF. A resin artificial kidney. J Lab Clin Med. 1948; 33(7):841-4.
[30] Pallotta AJ, Koppanyi T. The use of ion exchange resins in the treatment of phenobarbital intoxication in dogs. J Pharmacol Exp Ther. 1960; 128:318-27.
[31] SCHREINER GE. The Role of Hemodialysis (Artificial Kidney) in Acute Poisoning. AMA Arch Intern Med. 1958; 102(6):896-913.
[32] Bonavia A, Groff A, Karamchandani K, Singbartl K. Clinical Utility of Extracorporeal Cytokine Hemoadsorption Therapy: A Literature Review. Blood Purif. 2018; 46(4):337-49.
[33] He JQ, Chen CY, Deng JT, Qi HX, Zhang XQ, Chen JQ. The clinical study of artificial liver in the treatment of severe hepatitis. Zhongguo Weizhongbing Jijiu Yixue. 2000; 12: 105-108.
[34] Di Campli C, Zileri Dal Verme L, Andrisani MC, Armuzzi A, Candelli M, Gaspari R, et al. Advances in extracorporeal detoxification byMARS dialysis in patients with liver failure. Curr Med Chem. 2003; 10(4): 341-8.
[35] Poli EC, Rimmele T, Schneider AG. Hemoadsorption with CytoSorb(@). Intensive Care Med. 2019; 45(2):236-9.
[36] Basu R, Pathak S, Goyal J, Chaudhry R, Goel RB, Barwal A. Use of a novel hemoadsorption device for cytokine removal as adjuvant therapy in a patient with septic shock with multi-organ dysfunction: A case study. Indian J Crit Care Med. 2014; 18(12):822-4.
[37] Kogelmann K, JarczakD, Scheller M, Druner M. Hemoadsorption by CytoSorb in septic patients: a case series. Crit Care. 2017; 21(1):74.
[38] Hinz B, Jauch O, Noky T, Friesecke S, Abel P, Kaiser R. CytoSorb, a novel therapeutic approach for patients with septic shock: a case report. Int J Artif Organs. 2015; 38(8):461-4.
[39] Calabro MG, Febres D, Recca G, Lembo R, Fominskiy E, Scandroglio AM, et al. Blood Purification with CytoSorb in Critically Ill Patients: Single-Center Preliminary Experience. Artif Organs. 2019; 43(2):189-94.
[40] Friesecke S, Trager K, Schittek GA, Molnar Z, Bach F, Kogelmann K, et al. International registry on the use of the CytoSorb(R) adsorber in ICU patients: Study protocol and preliminary results. Med Klin Intensivmed Notfmed. 2019; 114(8):699-707.
[41] Klein DJ, Foster D, Walker PM, Bagshaw SM, Mekonnen H, Antonelli M. Polymyxin B hemoperfusion in endotoxemic septic shock patients without extreme endotoxemia: a post hoc analysis of the EUPHRATES trial. Intensive Care Med. 2018; 44(12):2205-12.
[42] Nakamura Y, Kitamura T, Kiyomi F, Hayakawa M, Hoshino K, Kawano Y, et al. Potential survival benefit of polymyxin B hemoperfusion in patients with septic shock: a propensity-matched cohort study. Crit Care. 2017; 21(1):134.
[43] Kodama Y, Takahashi G, Kan S, Masuda T, Ishibe Y, Akimaru R, et al. Use of Direct Hemoperfusion with Polymyxin B-Immobilized Fiber for the Treatment of Septic Shock Complicated with Lemierre Syndrome Caused by Fusobacterium necrophorum. Case Rep Crit Care. 2019; 2019:5740503
[44] Ankawi G, Fan W, Pomare Montin D, Lorenzin A, Neri M, Caprara C, et al. A New Series of Sorbent Devices forMultiple Clinical Purposes: Current Evidence and Future Directions. Blood Purif. 2019; 47(1-3):94-100.
[45] Huang Z, Wang SR, SuW, Liu JY. Removal of humoral mediators and the effect on the survival of septic patients by hemoperfusion with neutral microporous resin column. Ther Apher Dial. 2010;14(6):596-602.
[46] Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia. (Trial Version 6, Revised). 2020; Available from:›files›jsipc›protocolV65.
[47] Gong J, Dong H, XiaS Q, Huang YZ, Wang D, Zhao Y, et al. Correlation analysis between disease severity and inflammationrelated parameters in patients with COVID-19 pneumonia. medRxiv. 2020.
[48] Zhang C, Wu Z, Li J-W, Zhao H, Wang G-Q. The cytokine release syndrome (CRS) of severe COVID-19 and Interleukin-6 receptor (IL-6R) antagonist Tocilizumab may be the key to reduce the mortality. Int J Antimicrob Agents. 2020; 55(5): 105954.
[49] Bouadma L, Lescure FX, Lucet JC, Yazdanpanah Y, Timsit JF. Severe SARSCoV-2 infections: practical considerations and management strategy for intensivists. Intensive Care Med. 2020; 46(4): 579–82.
[50] Wang YT, Fu JJ, Li XL, Li YR, Li CF, Zhou CY. Effects of hemodialysis and hemoperfusion on inflammatory factors and nuclear transcription factors in peripheral blood cell of multiple organ dysfunction syndrome. Eur Rev Med Pharmacol Sci. 2016; 20(4):745-50.
[51] Rimmelé T, Kellum JA. Clinical review: blood purification for sepsis. Crit Care. 2011; 15(1): 205.
[52] Zhang C, Wu Z, Li J-W, Zhao H, Wang G-Q. The cytokine release syndrome (CRS) of severe COVID-19 and Interleukin-6 receptor (IL-6R) antagonist Tocilizumab may be the key to reduce the mortality. Int J Antimicrob Agents. 2020; 55(5):105954.
[53] Ronco C, Reis T, De Rosa S. Coronavirus epidemic and extracorporeal therapies in intensive care: si vis pacem para bellum. Blood Purif. 2020; 49(3):255-8.
IssueVol 7 No 3 (2021): Summer QRcode
SectionReview Article(s)
COVID-19 Hemoperfusion Inflammatory storms

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Moshari M, Mesbah Kiaei M, Hassani M. Review of the Potential of Hemoperfusion for the Treatment of Patients with Respiratory Infectious Diseases with COVID-19 Approach. Arch Anesth & Crit Care. 2021;7(3):171-175.