COVID-19 mortality among patients in the intensive care unit receiving mechanical ventilation is around 45%, and little data exists on the use of convalescent plasma in patients with COVID-19-induced acute respiratory distress syndrome (ARDS) receiving mechanical ventilation. To determine if high titer convalescent plasma reduces mortality among this population, researchers in Belgium conducted a randomized controlled trial. Between September 2020 and March 2022, researchers enrolled 475 patients (mean age, 64 years) with COVID-19-induced ARDS on mechanical ventilation for a maximum of 5 days at 17 sites. In total, 237 patients were randomized to receive two units of high titer convalescent plasma (at least 1:160) in addition to standard care, and 238 received standard care (98% of all patients received glucocorticoids). High titer convalescent plasma reduced 28-day mortality from 45.0% in the standard care arm to 35.4% in the convalescent plasma arm (p=0.03). Mortality was reduced to 32.7% if convalescent plasma was transfused within 48 hours of initiation of mechanical ventilation. Convalescent plasma may help reduce mortality for patients with COVID-19 ARDS.
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