Thank you for choosing to participate in our CytoSorb Literature Service where we regularly highlight publications and interesting CytoSorb treatment cases ("Case of the Week", published weekly online at www.cytosorb.com). In this exceptional month we are pleased to present a sepsis study including twenty patients in refractory septic shock, an ECMO and CytoSorb case study in a cardiac surgery patient, a venlafaxine intoxication case study and two ex vivo experimental studies. Finally the cases of the week include urosepsis, pancreatitis and suspected cholangitis.
Unfortunately we cannot provide you with complete published papers due to copyright reasons. Follow the link to be forwarded to the abstract in Pubmed. Subscribers will be able to download the full paper from here as usual, non-subscribers will only be able to download after registration.
Thank you very much for your interest.
With kind regards from Berlin
Harriet Adamson
Clinical Research Manager
Publications
Extracorporeal Cytokine Elimination as Rescue Therapy in Refractory Septic Shock - a Prospective Single-Center Study
Friesecke S, Stecher SS, Gross S, Felix SB, Nierhaus A
Journal Artif Organs 2017; epub
Summary
Mortality from refractory septic shock may reach 90-100% despite optimum therapy. In this study extracorporeal cytokine adsorption using CytoSorb in addition to regular therapy was studied prospectively in 20 patients with refractory shock (defined as increasing vasopressor dose required to maintain mean arterial blood pressure above 65 mmHg or increasing lactate levels despite protocol-guided shock therapy for six hours). CytoSorb® treatment was started after 7.8 ± 3.7 hours of shock therapy. Following the initiation of adsorption therapy, noradrenaline dose could be significantly reduced after 6 (p=0.03) and 12 hours (p=0.001). Lactate clearance improved significantly. Shock reversal was achieved in 13 (65%) patients; 28-day survival was 45% (predicted mortality from the SOFA score was >80%). The use of CytoSorb adsorption therapy resulted in shock reversal in two thirds of these particularly difficult to treat patients.
>> Link to abstract
ECMO and cytokine removal for bridging to surgery in a patient with ischemic ventricular septal defect - a case report
Marek S, Gamper G, Reining G, Bergmann P, Mayr H, Kliegel A.
Int J Artif Organs 2017; epub
Summary
Post-infarction ventricular septal defect (VSD) remains a serious and often lethal complication of percutaneous coronary intervention. It remains unclear whether surgery to correct this should be done immediately or delayed until after the patient is stabilized. This is a case report on the use of veno-arterial extracorporeal membrane oxygenation (ECMO) and extracorporeal blood purification therapy (CytoSorb®) in a 64-year-old patient with ischemic VSD leading to protracted cardiogenic shock and hemodynamic instability requiring large doses of catecholamines after a myocardial infarction. After a few hours with ECMO and CytoSorb the patient began to stabilize hemodynamically. The catecholamines (norepinephrine, dobutamine) and vasopressin could be significantly reduced (or stopped in the case of vasopressin) within the first 36 hours of treatment. After 4 days of treatment with ECMO and CytoSorb® therapy the patient was stable enough to be taken to surgery, where repair of the VSD and bypass grafting was successfully performed.
>> Link to abstract
Venlafaxine intoxication with development of takotsubo cardiomyopathy: successful use of extracorporeal life support, intravenous lipid emulsion and CytoSorb.
Schroeder I, Zoller M, Angstwurm M, Kur F, Frey L.
Int J Artif Organs 2017; epub
Summary
This case report describes a 19 yr old female who ingested 18g of venlafaxine - 240 times the daily therapeutic dose (a treatment for affective disorders) - who went on to develop severe takotsubo cardiomyopathy and multi-organ dysfunction syndrome. As there is minimal clearance of the drug with hemodialysis, and there is no specific antidote available, she was treated with intravenous lipid emulsion (ILE) and CytoSorb to enhance detoxification of the drug, and extracorporeal life support as a bridge to support the cardiac failure. Despite the relatively short use of CytoSorb (9 hours), a massive reduction in venlafaxine and its metabolites was observed under the combined therapy with ILE. Over time other therapies including the ECLS, ventilation, and dialysis could be withdrawn and the patient went on to make a full recovery.
>> Link to abstract
Cytokine filtration modulates pulmonary metabolism and edema formation during ex vivo lung perfusion
Iskender I, Cosgun T, Arni S, Trinkwitz M, Fehlings S, Yamada Y, Cesarovic N, Yu K, Frauenfelder T, Jungraithmayr W, Weder W, Inci I.
J Heart Lung Transplant 2017; epub
Summary
This study tested the safety and efficacy of cytokine adsorption during ex vivo lung perfusion (EVLP) in an animal model. Pig donor lungs were preserved for 24 hours at 4oC (to induce lung injury) and then randomly divided into 2 groups, the filter and control group (n=5 each), for a 12 hour EVLP procedure. In the filter group, the perfusate ran continuously through CytoSorb via a veno-venous shunt from the reservoir, whereas perfusions were run without additional filtering in the control group. Cytokine filtration with CytoSorb significantly improved airway pressure and dynamic compliance during the perfusion period. Electrolyte imbalance, glucose consumption and lactate production were markedly worse in the control group while cytokine expression profile, tissue myeloperoxidase activity and microscopic lung injury were significantly reduced in the CytoSorb treatment group. Continuous perfusate filtration through the CytoSorb beads was found to be effective and safe during prolonged EVLP and cytokine removal decreased the development of pulmonary edema and modulated pulmonary metabolism through the suppression of anerobic glycolysis and neutrophil activation.
>> Link to abstract
Ticagrelor Removal From Human Blood
Angheloiu GO, Gugiu GB, Ruse C, Pandey R, Dasari RR, Whatling C
JACC: Basic to Translational Science 2017; 2(2): 135 – 145
Summary
The authors devised a method for ticagrelor removal (platelet aggregation inhibitor) from blood using Cytosorbent hemadsorption in 2 sets of in vitro experiments. The first was a first-pass experiment using bovine serum albumin (BSA) solution pre-incubated with ticagrelor, whereas the second set, performed in a recirculating manner, used human blood mixed with ticagrelor. In the recirculation set up, Ticagrelor removal from BSA solution and human blood reached values of 90% and more already after 3 - 4 hours. CytoSorb hemadsorption was found to robustly remove ticagrelor from both BSA solutions and human blood samples.
>> Link to abstract
