Indications and outcomes of patients receiving therapeutic plasma exchange under critical care conditions: a retrospective eleven-year single-center study at a tertiary care center

Abstract Background: Therapeutic plasma exchange (TPE) to remove harmful or replace missing circulating plasma components is a well-established procedure with a wide range of disease indications. While per se is not among the daily routine of the intensivist TPE is frequently be performed under critical care conditions. However, data regarding TPE indications, patient characteristics and technical details on the intensive care unit (ICU) are sparse. Methods: We performed a retrospective, single-center study using data from January 2010 until August 2021 for patients treated with TPE in an ICU setting at the University Hospital Zurich. Data was collected from de-identified electronic patient medical records using specific search terms. Patient characteristics (including demographics, BMI, comorbidities, lab values and ICU-specific parameters, outcome), apheresis-specific technical parameters and complications were recorded and analyzed.Results: We identified n=105 patients meeting our inclusion criteria, with an even sex distribution (50.5% women) and median age of 56 (17-85) years. These 105 patients received a total of n=408 TPE treatments for 25 different indications. The most common indication were thrombotic microangiopathies (TMA) (38%), with thrombotic thrombocytopenic purpura (TTP) being the most prevalent sub-indication (27.6%). Level of evidence according to ASFA (American Society for Apheresis) guidelines varied and was well established in 63.8% of cases. Ten patients presented with TPE-related complications, with anaphylaxis being the most common. Bleeding complications were rare (1%). Median duration of ICU treatment was 8 ± 14 days. A total of 59 (56.2%), 26 (24.8%), and 35 (33.3%) patients needed ventilator, renal replacement or vasopressor support, respectively, with 6 (5.7%) needing extracorporeal membrane oxygenation. The overall survival in our critically ill patients treated with TPE was 88.6%.Conclusion: Our study provides a comprehensive overview of TPE indications in ICU patients at a major tertiary academic medical center and could serve as a point of reference for other comparable hospitals. Similar studies should be encouraged to establish reliable standards and ultimately improved treatment outcomes.