Case Report

The Role of Hemoperfusion in COVID-19 Infection: A Case Series


The rapid expansion of a novel human infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved into a pandemic, affecting thousands of people world wild. Some patients with coronavirus disease 2019 (COVID-19) develop severe infection, which may progress to acute respiratory distress syndrome, multiple organ failure, and death. Increasing studies indicate that abnormal elevation of cytokine levels in response to SARS-CoV-2 may contribute to the pathological process that leads mortality of COVID-19. Thus, application of extracorporeal hemoperfusion (HP) for removal of excessive cytokines from the blood can potentially mitigate or reverse cytokine storm related complications of COVID-19.
Here, we presented series of COVID-19 patients, who were treated with HP (HA 380 cartridge, Jafron Biomedocal Co, China). The medical records were evaluated retrospectively to determine the effect of HP on patients’ clinical outcome.
Our results showed that HP improvee PO2 and O2 saturation in patients with severe COVID-19. After the last courses of HP, 5 out of 6 patients were extubated and transferred to the general ward with an acceptable medical condition.
The following case series demonstrate the promising role of HP in controlling the consequential effect of cytokine storm following a COVID-19 infection, which could facilitate patient survival.

[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] McCreary EK, Pogue JM. Coronavirus disease 2019 treatment: a review of early and emerging options. Open Forum Infect Dis. 2020; 7(4):ofaa105.
[3] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497-506.
[4] Frimmel S, Schipper J, Henschel J, Yu TT, Mitzner SR, Koball S. First description of single‐pass albumin dialysis combined with cytokine adsorption in fulminant liver failure and hemophagocytic syndrome resulting from generalized herpes simplex virus 1 infection. Liver Transpl. 2014; 20(12):1523-4.
[5] Greil C, Roether F, La Rosée P, Grimbacher B, Duerschmied D, Warnatz K. Rescue of cytokine storm due to HLH by hemoadsorption in a CTLA4-deficient patient. J Clin Immunol. 2017; 37(3):273-6.
[6] Bottari G, Guzzo I, Marano M, Stoppa F, Ravà L, Di Nardo M, et al. Hemoperfusion with Cytosorb in pediatric patients with septic shock: A retrospective observational study. Int J Artif Organs. 2020; 43(9):587-93.
[7] Jamaati H, Dastan F, Tabarsi P, Marjani M, Saffaei A, Hashemian SM. A Fourteen-day Experience with Coronavirus Disease 2019 (COVID-19) Induced Acute Respiratory Distress Syndrome (ARDS): An Iranian Treatment Protocol. Iran J Pharm Res. 2020; 19(1):31-6.
[8] Ramos-Casals M, Brito-Zerón P, López-Guillermo A, Khamashta MA, Bosch X. Adult haemophagocytic syndrome. Lancet. 2014; 383(9927):1503-1516.
[9] Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. HLH Across Speciality Collaboration. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020; 395(10229):1033-4.
[10] Zhang C, Wu Z, Li JW, Zhao H, Wang GQ. 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.
[11] Takeda S, Munakata R, Abe S, Mii S, Suzuki M, Kashiwada T, et al. Hypercytokinemia with 2009 pandemic H1N1 (pH1N1) influenza successfully treated with polymyxin B-immobilized fiber column hemoperfusion. Intensive Care Med. 2010; 36(5):906-7.
[12] Safari S, Salimi A, Zali A, Jahangirifard A, Bastanhagh E, Aminnejad R, et al. Extracorporeal Hemoperfusion as a Potential Therapeutic Option for Severe COVID-19 patients; a Narrative Review. Arch Acad Emerg Med. 2020; 8(1):e67.
[13] Binh NG, Manabe T, Co DX, Tuan ND, Thach PT, Kudo K. Polymyxin‐B‐immobilized‐fiber column hemoperfusion with oseltamivir treatment for ARDS due to influenza H1N1/09. Respirol Case Rep. 2015; 3(2):57-60.
[14] Dastan F, Saffaei A, Mortazavi SM, Jamaati H, Adnani N, Samiee Roudi S, et al, Continues renal replacement therapy (CRRT) with disposable hemoperfusion cartridge: a promising option for severe COVID-19. J Glob Antimicrob Resist. 2020; 21:340-1.
[15] Li X, Ma X. Acute respiratory failure in COVID-19: is it “typical” ARDS? Crit Care. 2020; 24(1):198.
[16] Esmaeili Vardanjani A, Moayedi S, Golitaleb M. COVID-19 Pandemic Hemoperfusion Therapy Versus Plasma Exchange Therapy in Intensive Care. Iran J Allergy Asthma Immunol. 2020;19(S1):7-9.
IssueVol 7 No 3 (2021): Summer QRcode
SectionCase Report(s)
Coronavirus disease 2019 Hemoperfusion Acute Respiratory Distress Syndrome

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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Amirsavadkouhi A, Jahangirifard A, Shahrami R, Safari S, Feizabadi F, Mirshafiei Langari Z, Dastan A, Mirtajani S, Ghaznavi S, Dastan F. The Role of Hemoperfusion in COVID-19 Infection: A Case Series. Arch Anesth & Crit Care. 2021;7(3):189-194.