Last Verified: | June/30/2020 |
First Submitted: | July/20/2020 |
Estimated Enrollment Submitted: | July/21/2020 |
First Posted: | July/23/2020 |
Last Update Submitted: | July/21/2020 |
Last Update Posted: | July/23/2020 |
Actual Study Start Date: | March/31/2020 |
Estimated Primary Completion Date: | June/29/2020 |
Estimated Study Completion Date: | June/29/2020 |
Study Type: | Interventional |
Allocation: | Non-Randomized |
: | It was an interventional retrospective Propensity score matched (PSM) single centre based cohort study in Pak Emirates Military Hospital Rawalpindi (PEMH), Pakistan from 1st April to 30th June 2020. This study was carried out at the Department of Pulmonology and Critical care. PEMH is the largest Covid-19 designated hospital in the country. Data of all hospitalized patients is maintained by PEMH Covid-19 Research and evaluation cell. The study was approved by Institutional Review Board. |
Primary Purpose: | Treatment |
Masking: | None (Open Label) |
Arm | Intervention/treatment |
---|---|
Experimental: TPE Arm In addition to standard care TPE was performed once daily using COBE Spectra Apheresis machine version 7 (Manufacturer TERUMO BCT, Lakewood, CO, USA INC) having continuous flow centrifugation. Venous access was achieved using an ultrasound guided double lumen catheter (Arrow - 12 FR) via femoral vein. Patient's total blood volume was calculated as per Nadler's formula. Anticoagulant acid dextrose ratio was 1:10 and flow rate 30-40 ml/minutes (Adjusted as per hemodynamic status). Patients' blood pressure, pulse, oxygen saturation was monitored throughout procedure. Duration of procedure varied from 2-4 hours and 1-1.5 times total plasma volume was removed during each procedure. Replacement fluid was fresh frozen plasma (FFP) and normal saline in 2:1 respectively. All procedures were performed in intensive care or high dependency unit by Apheresis Department of PEMH. TPE was continued till recovery | Procedure: TPE Arm a. 1-1.5 plasma volume exchange, 2/3rd plasma should be replacing with FFP to avoid coagulopathy, adequate dieresis to prevent volume overload, 1-5 sessions in total, 1 session daily |
No Intervention: NON TPE arm Only supportive treatment offered including Vit C, Zinc, Vit D, famotidine, Enoxaparin and Methylprednisolone |
Ages Eligible for Study: | 18 Years to 18 Years |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | Yes |
Criteria: | Inclusion Criteria: - COVID-19 diagnosed by Polymerase Chain Reaction (PCR) positivity for SARS-CoV2 - CRS at presentation or developing during hospitalization - 10-80 years age and both genders - hospital admission - At least 1 completed session of plasma-exchange in patients included in TPE arm - No other novel therapy administered. Exclusion criteria were: - Death within 48 hours of admission - severe septic shock at time of admission - Congestive cardiac failure (EF<20%) (4) - Those receiving immunotherapy, Anti-thymocyte globulin or hematopoietic stem cell transplant in recent past - Patients of hematological or solid organ malignancies - patients receiving other investigational drugs including Tocilizumab, Convalescent plasma, Remdesivir, or Mesenchymal stem cells. |