Aquadex Ultrafiltration For Critical COVID Patients: Interview With John Erb, CEO At CHF Solutions

As the COVID-19 pandemic continues, many healthcare facilities around the world are inundated with critically ill patients, and resources such as equipment and staff are stretched thin. Shortages of critical equipment, such as ventilators, can mean the difference between life and death for patients, and the need to keep critically ill patients comfortable and alive has spurred healthcare staff and medtech companies to innovate and look for alternatives.

One example of this involves finding alternatives to dialysis machines. Certain critically ill COVID-19 patients are at risk of acute kidney injury, and dialysis is needed to help mitigate this. However, the crisis has meant that there are more patients than available dialysis machines, so doctors and nurses have been using alternative technology to fill the void.

Clinicians have been using the Aquadex ultrafiltration system from CHF Solutions to perform fluid removal when access to dialysis machines or technicians is not possible. The technique not only tides patients over until a dialysis machine is free, but it has also been used on COVID-19 patients who require fluid removal, and who are not suitable candidates for dialysis.

Medgadget had the opportunity to talk to John Erb, CEO at CHF Solutions about the current COVID-19 crisis and where Aquadex fits in.

Conn Hastings, Medgadget: How has the COVID-19 pandemic been exacerbated by equipment and staff shortages?



John Erb, CHF Solutions: This pandemic has been extremely challenging for our entire nation and has impacted all of us in one way or another. The incredibly brave health care providers who are risking their own health and safety in order to help others are enduring a significantly larger burden than the rest of us, and that burden continues to increase as the influx of patients is greater than available resources. We have seen a shortage of ventilators, PPE and now we are seeing a shortage in dialysis equipment. When there aren’t enough resources or staff to properly treat patients, providers are forced to triage patients, and lives are lost that may have been saved had there been proper support for those patients. This is why we want every hospital across the nation who is treating COVID-19 patients to know about ultrafiltration therapy and how it can help stabilize patients who need access to dialysis equipment – because it can mean life or death for some patients.

Medgadget: Why do critical COVID-19 patients suffer acute kidney injury, and what effects can the resulting fluid overload have?

John Erb: Acute kidney injury (AKI) often takes place in the setting of acute respiratory distress syndrome (ARDS), which is what COVID-19 causes. When the kidneys can’t remove the excess fluid and waste in the body, patients can experience kidney failure and multi-organ failure. This is obviously a very serious issue that requires immediate medical attention. The standard protocol is to use dialysis to cleanse the blood of excess sodium and waste and return it back to the body. The issue we are seeing is that with an influx of COVID-19 patients experiencing AKI, there are not enough dialysis machines to accommodate the number of patients who need them. Our Aquadex ultrafiltration therapy can quickly and effectively help stabilize patients until a dialysis machine becomes available, buying time for patients who would otherwise have no therapy available to them.

Medgadget: Please give us an overview of the Aquadex system and how it works.

John Erb: Aquadex is a portable ultrafiltration system that removes excess fluid from the body. A physician prescribes the therapy, and a nurse administers it. It removes 5-40 mL of blood per minute, runs the blood through a filter to remove excess fluid and the blood is returned to the body. The blood is out of the body and filtered for one minute. By removing a small amount of blood and quickly returning it, we’re able to gently treat the patient with little risk of complication.

The system was initially used to remove the extra 4-5 liters of fluid cardiology patients have during cardiac procedures. This extra fluid must be removed before the patient can come off of the ventilator and leave the ICU. As physicians began to recognize the need for fluid management in COVID-19 patients, they quickly turned to Aquadex as a resource to maintain fluid balance in patients experiencing fluid overload.

Medgadget: How does the system compare with a dialysis machine?

John Erb: dialysis is a powerful and important treatment when the kidneys are unable to function or failing, but it can be taxing on the patient. dialysis can remove 300-500 mL of blood per minute and can filter around 2,000 mL an hour. Aquadex takes up to 500 mL an hour and is much gentler on the patient. Since COVID patients have excess fluid in the lungs and they are also receiving drugs that add fluid, Aquadex can help maintain and balance this fluid to mitigate the adverse outcomes of fluid overload.

Aquadex isn’t a replacement for dialysis but it enables providers to customize their fluid removal strategy for each patient, and it is an easy and gentle way to help maintain fluid balance. Using the two treatment options together is often optimal. Aquadex is often used between dialysis treatments or to stabilize patients when there are no dialysis machines available. Aquadex also helps patients who are unable to receive dialysis treatment.

Nephrologists are balancing the use of dialysis treatment and our treatment for COVID patients. Aquadex takes off the extra fluid, and dialysis removes waste when the kidneys aren’t functioning. dialysis requires a nephrologist or specialized dialysis nurse to operate the machine and be present for the duration of the therapy. In contrast, any physician or nurse can operate Aquadex and can leave the room while it’s in use, reducing required staff support by a factor of four. Physicians have expressed that this is an immense benefit as it alleviates the staffing shortage burden and it reduces the number of nurses exposed to COVID-19 patients, and their level of exposure.

Medgadget: How has the Aquadex system been used to treat COVID-19 patients to date?

John Erb: Aquadex has been used to help stabilize patients when dialysis equipment is unavailable. Many coronavirus hotspots such as New York City and Georgia have seen a shortage in dialysis equipment. It’s crucial to quickly treat patients experiencing acute kidney injury and Aquadex buys time for these patients as they wait for dialysis resources to open up. In a recent clinician-led webinar sponsored by CHF Solutions, physicians in New York City and Albany, Georgia discussed how ultrafiltration with Aquadex is helping them treat their COVID-19 patients. Physicians from around the country tuned in to ask advice and discuss fluid management challenges they’ve experienced. For anyone interested, you can access the replay of the webinar to hear real-world case studies of how Aquadex has been used during this pandemic.

Medgadget: Do you have any plans to make more of the units available, in the context of the current pandemic?

John Erb: Absolutely. Product sales of Aquadex to six hospitals in New York City have increased over 300% and we’ve doubled our production staff that builds the Aquadex SmartFlow consoles in response to the increased demand from hospitals due to the coronavirus. We are working closely with hospitals across the nation to ensure that our therapy is available to help treat their COVID-19 patients.

As this virus wreaks havoc on our health care system, we are dedicated to supporting providers and patients in any way we can. We are fortunate to be able to offer a product that can help save the lives of patients who are battling this virus while helping to reduce exposure to our fearless providers on the front lines.

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