Table 3.
Summary of recommendations from major guidelines and consensus as well as published literature on use of therapeutic options for cytokine storm in COVID-19
| Guideline/consensus/authors | Low-dose steroid | High-dose vitamin C | Serine protease inhibitor (e.g., ulinastatin) | Heparins (UFH, LMWH) | Other immunosuppressant (e.g., tocilizumab) | Blood purification system (e.g., CRRT) |
|---|---|---|---|---|---|---|
| WHO3 | No | ND | ND | ND | ND | ND |
| SCCM and ESICM17 | ND | ND | ND | ND | ND | ND |
| MOHFW, India37 | ND | ND | ND | ND | ND | ND |
| ISCCM position statement38 | No | ND | ND | ND | Yes | ND |
| Shanghai Medical Association consensus19 | Yes | Yes | Yes | Yes | ND | ND |
| Ye et al.39 | Yes* | ND | Yes | ND | Yes | Yes |
| Sun et al.40 | No | ND | ND | ND | Yes | Yes |
| Russell et al.20 | Yes | ND | ND | ND | No | ND |
| Jose and Manuel12 | ND | ND | ND | Yes | ND | ND |
*
Steroid such as methylprednisolone to be used at 1–2 mg/kg/day for 3–5 days only. WHO, World Health Organization; SCCM and ESICM, Society of Critical Care Medicine and the European Society of Intensive Care Medicine; ISCCM, Indian Society of Critical Care Medicine; UFH, unfractionated heparin; LMWH, low-molecular-weight heparin; CRRT, continuous renal replacement therapy, ND: not discussed