Dialysis for treating COVID?

[cmb]

TL;DR Summary

Can an improved form of dialysis treat COVID?

I am watching the video in this post;-

https://www.physicsforums.com/threa...es-over-time-a-big-issue.1008171/post-6554749

(yes, I do fully read and try to understand people's posts, not sure it is reciprocated)

and I was unaware of the content of the video, where he says the reason for hypoxia is due to micro clotting (see at 10'22'' specifically) got me thinking;-



If that is the case, then can't we do something 'engineering based' about that, by taking the blood out and filtering out these microclots?

I imagine a regular dialysis machine would clot up, but I am sure a machine designed to flow and filter blood that is in the process of forming microclots can be devised to do that job with?

Just a thought. Could this work and if so has this approach been considered/tried already?

Reason no such machine already exists is, as this guy says, there has never been a disease like this before. So maybe time to make such a machine?

 

[pinball1970]

Summary:: Can an improved form of dialysis treat COVID?

I am watching the video in this post;-

https://www.physicsforums.com/threa...es-over-time-a-big-issue.1008171/post-6554749

(yes, I do fully read and try to understand people's posts, not sure it is reciprocated)

and I was unaware of the content of the video, where he says the reason for hypoxia is due to micro clotting (see at 10'22'' specifically) got me thinking;-



If that is the case, then can't we do something 'engineering based' about that, by taking the blood out and filtering out these microclots?

I imagine a regular dialysis machine would clot up, but I am sure a machine designed to flow and filter blood that is in the process of forming microclots can be devised to do that job with?

Just a thought. Could this work and if so has this approach been considered/tried already?

Reason no such machine already exists is, as this guy says, there has never been a disease like this before. So maybe time to make such a machine?

Ok intuitively that made sense but can you post some of the published papers time lining the points?
I know all the guys have posted papers on some of the pathologies already.
Be good to timeline this though, if all those points are supported.

 

[jim mcnamara]

ECMO (major dialysis with oxygen exchanger) is currently used for some patients with extremely serious symptoms. Usually after patients start to fail on ventilators. It involves oxygenating blood that is rerouted out the thigh, into the ECMO, back into the blood stream.

So you have a good idea in that what you suggest could be done. No major problem conceptually.

ECMO is a high volume dialysis system. In use as we speak.
Except a coicnern may be perhaps how to remove clotting and keep patients healthy. And get access ECMO-like machines. Or maybe dialysis machines could perform the task. I do not know any research on this topic.

Note: ECMO is a big deal clinically. It is also limited in availability because it mostly is used in for newborns, with heart/lung problems. Patients are often airlifted to fairly distant sites that have the staff and available ECMO devices. This is in New Mexico.

However. ECMO is considered an extremely last resort, because of increased risk problems.

The clot issue has a much less intrusive answer:
Low molecular weight heparin (an antithrombotic - prevents clotting) is one of the major treatment modalities for patients considered at risk for severe clotting. Usually administered before micro-clots become a problem. Otherwise it has no benefit. It has to be monitored so that patients do not develop internal bleeding. It is not a trivial drug, people can die from poorly monitored use.

ECMO guidance from the CDC:
https://www.covid19treatmentguidelines.nih.gov/management/critical-care/extracorporeal-membrane-oxygenation/

Heparin guidance from the CDC:
https://www.covid19treatmentguidelines.nih.gov/therapies/antithrombotic-therapy/

Consider this:
The point is to prevent clotting in the first place. Why? Ex post facto remediation may run into the problem that the microclots form on/around the alveoli and do not necessarily float around loose. I do not know how valuable removing clots after formation would be for patient survival.

And once the clots form, then the pathology really "hits the fan", i.e., escalates rapidly.

This is about microclots:
https://pubmed.ncbi.nlm.nih.gov/32972126/
Explains what I am talking about. The microclot damaged area looks like ground glass in thoracic X-rays.
Clots do get around and cause problems, as you would expect, but the primary damage zone is the alveoli in the lungs. They stay there in droves. Plus it is not just the clots. The immune system overreacts and trashes alveolar tissues as well. Cytokine storm.

The pathology of Covid is truly complex. This is one big reason it took the medical community extensive effort to work out the guidelines above.