Introduction: Our understanding of the COVID-19 disease has been steadily evolving since the original outbreak in December 2019. Advanced disease is characterised by a hyperin ammatory state, systemic coagulopathies and multiorgan involvement, in particular respiratory distress.We here describe our initial experience with treating of COVID-19 patients based on early initiation of extracorporeal blood puri cation, systemic heparinisation and respiratory support.Methods: 15 patients were included; 2 were females. We monitored real-time several biochemical, immunological and coagulation biomarkers associated with disease severity following admission to our dedicated COVID-19 intensive care unit. To guide personalised treatment, we monitored among others levels of IL-6, IL-8, TNF-α, C-Reactive Protein (CRP), Neutrophil-to-Lymphocyte ratios, Thrombocyte counts, D-Dimers, Fibrinogen, and Activation Clotting time (ACT).Treatment consisted of individualised respiratory support supplemented with 1 -4 cycles of 24-hour Extracorporeal Organ Support (ECOS) and Blood Puri cation using the AN69ST (oXiris ® ) hemo lter. We administered heparin (300 U/kg) to counter suspected hypercoagulability (= elevated Fibrinogen or Ddimers) states to maintain ACT ≥ 180 seconds.Results: N = 10 presented with severe to critical disease (= dyspnoea, hypoxia, respiratory rate > 30/min, peripheral oxygen saturation < 90%, or > 50% lung involvement on X-ray imaging). A single case was admitted with a critical condition (= respiratory failure). One patient died after 5 days of hospitalisation after developing Acute Respiratory Syndrome. 8 Patients have been discharged -average ICU length-ofstay was 9.9 ± 2.4 days. Clinical improvement was associated with normalisation (increase) of thrombocytes, white blood cells, stable levels of IL-6 (< 50 ng/mL) and a decrease of CRP and Fibrinogen.
Conclusion:Means to monitor COVID-19 disease severity during hospitalisation are crucial to control disease progression and prevent hyperin ammation and irreversible multiorgan failure. We present here a real-time monitoring system accounting for biochemical, immunological, coagulation parameters and radiological imaging.The combination of systemic heparin anticoagulation regimens and blood puri cation may prevent hyperin ammation, thromboembolism during hospitalisation and thus support clinical recovery.