Lack of eligible COVID-ICU patients

This is an Early Feasibility Study (EFS) investigating the use of the Hemopurifier® in the treatment of SARS-CoV-2 Virus Disease (COVID-19).

Up to 40 ICU patients with severe or critical illness due to confirmed COVID-19 infection will be enrolled in up to 20 investigational sites. Patients will receive a four to six-hour treatment with the Hemopurifier® extracorporeal therapy daily for up to four days until discontinued because of clinical improvement or deterioration or upon the decision of the Principal Investigator. The patients will be monitored closely with vital signs and for hemodynamic stability. Patients will be followed for adverse events and device deficiencies. Blood work will be obtained.

Inclusion Criteria:

1. Laboratory diagnosis of COVID-19 infection with any of the following disease characteristics:

   i. Early acute lung injury (ALI)/early acute respiratory distress syndrome (ARDS) ii. Severe disease, defined as:

   • dyspnea,

   • respiratory frequency ≥ 30/min,

   • blood oxygen saturation ≤ 93%,,

   • partial pressure of arterial oxygen to fraction of inspired oxygen ratio of <300 and/or

   • lung infiltrates >50% within 24 to 48 hours; iii. Life-threatening disease, defined as:

     1. respiratory failure,
     2. septic shock, and/or
     3. multiple organ dysfunction or failure.

2. Admission to the ICU or area of the hospital repurposed to function as an ICU for surge capacity management

3. Subject has maintained a MAP of > or = 65 without an increased dose of vasopressors for at least 2 hours and has clinical evidence of adequate volume status per investigative site criteria

4. Informed consent from the patient or legally authorized representative

5. Age > 18

Exclusion Criteria:

1. Stroke (known or suspected) within the last 3 months.

2. Severe congestive heart failure (NYHA III and IV classes).

3. Biopsy proven cancer not in remission.

4. Acute (an international normalized ratio (INR) of greater than 1.5, and any degree of mental alteration (encephalopathy) in a patient without preexisting cirrhosis and with an illness of less than 26weeks' duration or chronic (Child Pugh C) liver disease.

5. Known pre-existing non-COVID-19 related hypercoagulability or other coagulopathy

6. Terminal illness with a life expectancy of < 28 days or for whom a decision of withdrawal of care is in place or imminently anticipated or patients who have received prior extracorporeal therapy and had persistent, unstable hypotension.

7. Patients with known hypersensitivity to any component of the Hemopurifier.

8. Advance directive indicating to withhold life-sustaining treatment (except Cardiopulmonary Resuscitation).

9. Contraindications to extracorporeal blood purification therapy such as:

   i. Clinically relevant bleeding disorder, ii. Contraindication to anti-coagulation, iii. Pregnancy, iv. Inability to establish functional vascular access, v. Participation in another competing investigational drug, device or vaccine trial vi. Administration of an angiotensin converting enzyme (ACE) inhibitor in the previous 14 days. vii. Platelet count < 50,000 cells/microliter