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.

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.

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.  

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

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

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

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.

Info page: Aquadex ultrafiltration system…

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