CytoSorbents Corporation (CTSO)

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Case of the week 10/2016
Use of CytoSorb in a case of severe post reanimation shock

Dr. med. Hendrik Haake, Dr. med. Katharina Grün-Himmelmann & Prof. Jürgen vom Dahl
St. Franziskus-Hospital Mönchengladbach, Germany,Department of Cardiology and Intensive Care Medicine
Summary:

This case study reports on a 63-year-old male patient who was admitted to hospital after cardiac arrest with ventricular fibrillation and successful cardiopulmonary resuscitation for 20 minutes.
Case presentation

Patient was admitted to ICU with mechanical ventilation and moderate demand for catecholamines (noradrenaline 0.5 mg/h)
Instantaneous cardiac catheter examination with exclusion of coronary heart disease
Immediate hypothermia treatment for 24 hours at 34°C
Thereafter warming up at 0.25°C/hour until target temperature of 36°C
PiCCO-guided catecholamine and volume therapy due to ensuing hemodynamic instability and progressively increasing needs for catecholamines
Development of oliguric acute kidney failure and a shock pancreas with considerably elevated lipase plasma levels (6000 U/l)
Due to the acute kidney failure and the progressive need for catecholamines (NOR 10 mg/h, dobutamine 50 mg/h) a CytoSorb adsorber was installed in combination with CVVHD
Treatment

One CytoSorb treatment for 48 hours
CytoSorb was used in conjunction with CRRT (Multifiltrate, Fresenius Medical Care) in CVVHD mode
Blood flow rate: 150 ml/min
Anticoagulation: heparin
CytoSorb adsorber position: pre-hemofilter
Measurements

Hemodynamic variables measured using PiCCO (CI, SVRI, ITBVI)
Demand for catecholamines
Renal function (creatinine, urea, diuresis)
Inflammatory parameters (CRP, PCT, WBC)
Results

Hemodynamic stabilization (CI, SVRI, ITBVI) of the patient along with significantly decreased needs for catecholamines within 14 hours (noradrenaline 2 mg/h, dobutamine 30 mg/h )
Significantly declining renal retention parameters under CVVHD
Reduction of inflammatory parameters (CRP, WBC)
Patient Follow-Up

In the further course development of a bilateral pneumonia necessitating installation of veno-venous ECMO for another 9 days
Termination of renal replacement therapy 6 days after initial CytoSorb treatment
Subsequent transfer to IMC and several days later to general ward
Finally, implantation of an automatic cardioverter-defibrillator and successful transfer of patient to a rehabilitation unit
Conclusions

Successful application of CytoSorb in a case of post-reanimation shock
Treatment with CytoSorb resulted in significant stabilization of hemodynamics with declining needs for catecholamines within a few hours
Application of CytoSorb was safe and easy

http://cytosorb-therapy.com/the-therapy/case-of-the-week/