Hartman William R, Hess Aaron S, Connor Joseph P
Department of Anesthesiology, University of Wisconsin-Madison, Madison, USA.
Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, USA.
Transl Med Commun. 2020;5(1):17. doi: 10.1186/s41231-020-00068-9. Epub 2020 Oct 12.
SARS-CoV-2 and its associated disease, COVID-19, has infected over seven million people world-wide, including two million people in the United States. While many people recover from the virus uneventfully, a subset of patients will require hospital admission, some with intensive care needs including intubation, and mechanical ventilation. To date there is no cure and no vaccine is available. Passive immunotherapy by the transfusion of convalescent plasma donated by COVID-19 recovered patients might be an effective option to combat the virus, especially if used early in the course of disease. Here we report our experience of using convalescent plasma at a tertiary care center in a mid-size, midwestern city that did not experience an overwhelming patient surge.
Hospitalized COVID-19 patients categorized as having Severe or Life-Threatening disease according to the Mayo Clinic Emergency Access Protocol were screened, consented, and treated with convalescent plasma collected from local donors recovered from COVID-19 infection. Clinical data and outcomes were collected retrospectively.
31 patients were treated, 16 severe patients and 15 life-threatened patients. Overall mortality was 27% (4/31) but only patients with life-threatening disease died. 94% of transfused patients with severe disease avoided escalation to ICU care and mechanical ventilation. 67% of patients with life-threatening disease were able to be extubated. Most transfused patients had a rapid decrease in their respiratory support requirements on or about day 7 following convalescent plasma transfusion.
Our results demonstrate that convalescent plasma is associated with reducing ventilatory requirements in patients with both severe and life-threatening disease, but appears to be most beneficial when administered early in the course of disease when patients meet the criteria for severe illness.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）及其相关疾病新冠肺炎已在全球感染了超过700万人，其中包括美国的200万人。虽然许多人能顺利从病毒感染中康复，但一部分患者需要住院治疗，有些患者还需要重症监护，包括插管和机械通气。迄今为止，尚无治愈方法，也没有可用的疫苗。输注新冠肺炎康复患者捐献的康复期血浆进行被动免疫治疗可能是对抗该病毒的有效选择，尤其是在疾病早期使用时。在此，我们报告我们在中西部一个中等规模城市的三级医疗中心使用康复期血浆的经验，该中心并未出现患者大量涌入的情况。
根据梅奥诊所紧急就诊方案，对被归类为患有严重或危及生命疾病的住院新冠肺炎患者进行筛查、征得同意，并使用从当地新冠肺炎康复捐献者采集的康复期血浆进行治疗。回顾性收集临床数据和结果。
共治疗31例患者，其中16例为重症患者，15例为危及生命的患者。总体死亡率为27%（4/31），但只有危及生命的患者死亡。94%的重症输血患者避免了升级到重症监护和机械通气。67%的危及生命的患者能够拔管。大多数输血患者在输注康复期血浆后第7天左右呼吸支持需求迅速下降。
我们的结果表明，康复期血浆与降低重症和危及生命疾病患者的通气需求相关，但在患者符合重症标准且疾病早期给药时似乎最为有益。
