The Latest in Critical Care, 11/6/23 (Issue #19)
Convalescent plasma for severe Covid-19; Cryoprecipitate for massive hemorrhage (CRYOSTAT-2); Aortic balloon occlusion for trauma (UK-REBOA)
Convalescent plasma for ARDS due to Covid-19
Convalescent plasma, donated by patients after recovering from Covid-19 and distributed by the Red Cross, represented one of the many ethical and policy controversies generated by the pandemic. The therapy was approved for emergency use in 2020 by FDA after an observational study of 10 patients showed likely benefit (yes, 10, which should remind us of our collective desperation). The critical care world split into clinicians who “liked” plasma and those who held back on its use due to the lack of robust evidence.
Numerous randomized trials were performed, and were largely negative. Small positive studies were widely considered outliers, or biased. Convalescent plasma, it was concluded, didn’t help patients with severe Covid-19 as a general group. Intuitively, plasma seemed even less likely to help the very sickest of the sick— those mechanically ventilated with ARDS from Covid-19, whose mortality rate was well over 50% at many centers.
Only i…
Keep reading with a 7-day free trial
Subscribe to PulmCCM to keep reading this post and get 7 days of free access to the full post archives.