CytoSorbents Corporation (CTSO)

[andy55q]

Wow! What filter are they using on the patient in Germany??
"The patient in Germany underwent an experimental treatment for blood purification in septic shock designed more to enhance removal of nonrenal toxins/cytokines associated with severe infection."


Published: Oct 20, 2014

By Kristina Fiore, Staff Writer, MedPage Today




For some Ebola patients dialysis has been a key part of their treatment, but the procedure raises concern about transmission risk given exposure to infected blood.
Emory University Hospital in Atlanta has now been involved in the care of four Ebola patients. Two nephrologists there --Michael Connor, MD, and Harold Franch, MD -- answered questions about dialysis for Ebola in an email exchange withMedPage Today.
At what point do you initiate dialysis in an Ebola patient?
Indications for dialysis are similar to those without Ebola. In the setting of acute kidney injury, dialysis should be considered for acute initiation if:
Symptomatic volume overload develops
Minimal urine output and unresponsive to diuretics
Severe electrolyte derangements or severe acidemia
Symptomatic accumulation of uremic toxins
There is no specific indication for dialysis in Ebola, which would differ from general critically ill patients.
Does regular dialysis work, or do you need a special filtration device, such as the one being used for the patient in Germany?
Conventional filter technologies are sufficient for dialysis of EVD [Ebola virus disease] patients. The patient in Germany underwent an experimental treatment for blood purification in septic shock designed more to enhance removal of nonrenal toxins/cytokines associated with severe infection. They also were interested if the virus itself would be removed. Like all experimental therapies, it is not clear if there will be clinical benefit from their approach, and we look forward to seeing presentations of their data.
Are there any other special approaches to dialysis in this population?
We recommend using continuous renal replacement therapy (CRRT) technologies using regional citrate anticoagulation (RCA) in patients with Ebola. CRRT with RCA should decrease the production of hazardous/infectious waste by decreasing filter exchanges; decrease need for healthcare worker connection/disconnection of circuit from the patients' vascular access; and decrease rate of spent dialysate production. CRRT can be performed by ICU nurses, reducing the need for additional personnel to enter the room. By changing the settings, CRRT machines can also be used for intermittent dialysis, thus allowing changes in modality without bringing additional equipment into the room.
Is there an increased risk of exposure given that healthcare workers are dealing with the infected patient's blood?
Yes, there is an increased risk of exposure in that dialysis requires interaction of staff with blood from vascular access sites and requires insertion of dedicated dialysis vascular access. There is nothing about performing renal replacement therapy that should increase the risk for a breach in personal protective equipment. However, in our opinion, renal replacement therapy should be prescribed in a manner that maximizes staff safety by limiting the number of people who enter the room, the amount of equipment and waste that comes out of the room, and the amount and number of times that staff has exposure to contagious blood.
Are there special prevention protocols in place when dialyzing an Ebola patient?
To date, there are no published guidelines or protocol for providing renal replacement therapy in patients with Ebola. This is largely because the collective experience globally in providing dialysis in Ebola remains in the single digits. Emory will publish our experience shortly as a model for other centers' consideration. It is our understanding that the CDC and the American Society of Nephrology are in the process of preparing more comprehensive guidance for dialysis in EVD patients.
http://www.medpagetoday.com/Nephrology/GeneralNephrology/48154