Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Targeted High Volume Hemofiltration Could Avoid Extracorporeal Membrane Oxygenation in Some Patients with Severe Hantavirus Cardiopulmonary Syndrome

René López
ORCID logo ,
Rodrigo Pérez-Araos
ORCID logo ,
Álvaro Salazar
,
Mauricio Espinoza
,
Cecilia Vial
,
Analia Cuiza
,
Pablo A. Vial
ORCID logo ,
Jerónimo Graf
* ORCID logo
Version 1 : Received: 4 July 2020 / Approved: 5 July 2020 / Online: 5 July 2020 (05:24:11 CEST)

A peer-reviewed article of this Preprint also exists.

López, R, Pérez-Araos, R, Salazar, Á, et al. Targeted high volume hemofiltration could avoid extracorporeal membrane oxygenation in some patients with severe Hantavirus cardiopulmonary syndrome. J Med Virol. 2021; 93: 4738-4747. https://doi.org/10.1002/jmv.26930 López, R, Pérez-Araos, R, Salazar, Á, et al. Targeted high volume hemofiltration could avoid extracorporeal membrane oxygenation in some patients with severe Hantavirus cardiopulmonary syndrome. J Med Virol. 2021; 93: 4738-4747. https://doi.org/10.1002/jmv.26930

Abstract

Background: Hantavirus cardiopulmonary syndrome (HCPS) has a high lethality. About two-thirds of the severe cases may be rescued by extracorporeal membrane oxygenation (ECMO). However, about half of the patients supported by ECMO suffer major complications. High volume hemofiltration (HVHF) is a depurative extracorporeal support that provides homeostatic balance allowing hemodynamic stabilization in some critically ill patients. Methods: We implemented HVHF prior to ECMO consideration in the last five severe HCPS patients requiring mechanical ventilation and vasoactive drugs admitted to our intensive care unit. Patients were considered HVHF-responders if ECMO was avoided and nonresponders if ECMO support was needed. Results: The first two patients required ECMO, while the last three did not. Patients had a maximum serum lactate of 8.4 [4.3-14] mMol/L and a lowest cardiac index of 1.76 [1.45-2.9] L/min/m2. Nonresponders were connected later to HVHF, displayed progressive tachycardia and decreasing stroke volume. The opposite was true for HVHF-responders who also received targeted-HVHF compounded by aggressive hyperoncotic albumin, sodium bicarbonate and calcium supplementation plus ultrafiltration to avoid fluid overload. All patients survived, but one of the ECMO patients suffered a vascular complication. Conclusion: HVHF may contribute to support severe HCPS patients avoiding the need for ECMO in some of them. Early connection and targeted-HVHF may increase the chance of success.

Keywords

Hantavirus cardiopulmonary syndrome; Hantavirus pulmonary syndrome; extracorporeal membrane oxygenation; transpulmonary thermodilution; high volume hemofiltration; Andes Hantavirus

Subject

Medicine and Pharmacology, Pulmonary and Respiratory Medicine

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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