Management of remdesivir extravasation in patients with COVID: a case report and systematic review

What is it about?

Extravasation is a common and potentially severe complication of intravenous drug administration. The COVID-19 pandemic has resulted in a rapid upsurge in the use of remdesivir. Data about complications experienced during use of the drug are limited. The authors describe here the first case report of a patient with remdesivir extravasation in the UK, and a systematic review of all known cases worldwide, as well as their management and long term sequelae. Oedema was reported in all cases, erythema in five cases and pain in four cases. The one case with persistent sequelae had delayed diagnosis which may have caused potential for more severe injury. The two cases which had the fastest resolution of symptoms were those where the extravasation was noticed part-way through the infusion, hinting at a dose-dependent relationship. The acidic pH of remdesivir and high infiltration volumes are the factors which most likely explain the mechanism of tissue injury and should be the targets on which to base a treatment strategy. The clearest recommendation from our review is the importance of awareness to recognise injury early and prevent the most severe sequelae. The authors propose a recommendation for aspiration and hyaluronidase injection to “disperse and dilute” remdesivir.

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