Extracorporeal Blood Purification and Organ Support in the Critically Ill Patient during COVID-19 Pandemic: Expert Review and Recommendation

Blood Purif. 2021;50(1):17-27. doi: 10.1159/000508125. Epub 2020 May 26.


Critically ill COVID-19 patients are generally admitted to the ICU for respiratory insufficiency which can evolve into a multiple-organ dysfunction syndrome requiring extracorporeal organ support. Ongoing advances in technology and science and progress in information technology support the development of integrated multi-organ support platforms for personalized treatment according to the changing needs of the patient. Based on pathophysiological derangements observed in COVID-19 patients, a rationale emerges for sequential extracorporeal therapies designed to remove inflammatory mediators and support different organ systems. In the absence of vaccines or direct therapy for COVID-19, extracorporeal therapies could represent an option to prevent organ failure and improve survival. The enormous demand in care for COVID-19 patients requires an immediate response from the scientific community. Thus, a detailed review of the available technology is provided by experts followed by a series of recommendation based on current experience and opinions, while waiting for generation of robust evidence from trials.

Keywords: Continuous renal replacement therapies; Cytokine removal; Extracorporeal organ support; Hemoadsorption; Hemoperfusion.

Publication types

  • Review

MeSH terms

  • COVID-19 / blood
  • COVID-19 / complications
  • COVID-19 / therapy*
  • Continuous Renal Replacement Therapy / instrumentation
  • Continuous Renal Replacement Therapy / methods*
  • Critical Illness / epidemiology
  • Critical Illness / therapy*
  • Cytokines / blood
  • Cytokines / isolation & purification
  • Equipment Design
  • Extracorporeal Membrane Oxygenation / instrumentation
  • Extracorporeal Membrane Oxygenation / methods*
  • Hemoperfusion / instrumentation
  • Hemoperfusion / methods*
  • Humans
  • Multiple Organ Failure / blood
  • Multiple Organ Failure / etiology
  • Multiple Organ Failure / therapy*


  • Cytokines