Extracorporeal multiorgan support including CO<sub>2</sub>-removal with the ADVanced Organ Support (ADVOS) system for COVID-19: A case report

  • Wolfgang Huber (Contributor)
  • Georg Lorenz (Contributor)
  • Markus Heilmaier (Contributor)
  • Katrin Böttcher (Contributor)
  • Philipp Sahm (Contributor)
  • Moritz Middelhoff (Contributor)
  • Barbara Ritzer (Contributor)
  • Dominik Schulz (Contributor)
  • Elias Bekka (Contributor)
  • Felix Hesse (Contributor)
  • Alexander Poszler (Contributor)
  • Fabian Geisler (Contributor)
  • Spinner Christoph (Contributor)
  • R. M. Schmid (Contributor)
  • Tobias Lahmer (Contributor)



<div><p>A substantial part of COVID-19-patients suffers from multi-organ failure (MOF). We report on an 80-year old patient with pulmonary, renal, circulatory, and hepatic failure. We decided against the use of extracorporeal membrane oxygenation (ECMO) due to old age and a SOFA-score of 13. However, the patient was continuously treated with the extracorporeal multi-organ- “ADVanced Organ Support” (ADVOS) device (ADVITOS GmbH, Munich, Germany). During eight 24h-treatment-sessions blood flow (100–300 mL/min), dialysate flow (160–320 mL/min) and dialysate pH (7.6–9.0) were adapted to optimize arterial PaCO<sub>2</sub> and pH. Effective CO<sub>2</sub> removal and correction of acidosis could be demonstrated by mean arterial- versus post-dialyzer values of pCO<sub>2</sub> (68.7 ± 13.8 vs. 26.9 ± 11.6 mmHg; <i>p</i> < 0.001). The CO<sub>2</sub>-elimination rate was 48 ± 23mL/min. The initial vasopressor requirement could be reduced in parallel to pH-normalization. Interruptions of ADVOS-treatment repeatedly resulted in reversible deteriorations of p<sub>a</sub>CO<sub>2</sub> and pH. After 95 h of continuous extracorporeal decarboxylating therapy the patient had markedly improved circulatory parameters compared to baseline. In the context of secondary pulmonary infection and progressive liver failure, the patient had a sudden cardiac arrest. In accordance with the presumed patient will, we decided against mechanical resuscitation. Irrespective of the outcome we conclude that extracorporeal CO<sub>2</sub> removal and multiorgan-support were feasible in this COVID-19-patient. Combined and less invasive approaches such as ADVOS might be considered in old-age-COVID-19 patients with MOF.</p></div>
Date made available1 Jan 2020
PublisherFigshare - Sage

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