CytoSorbents Corporation (CTSO)

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American Journal of Case Reports
IF 2022: 1.2

05 July 2023 : Case report Belgium

[In Press]ECMO and Extracorporeal Blood Purification with CytoSorb® Adsorber for Tricyclic Antidepressant Poisoning with Cardiogenic Shock and Severe Rhabdomyolysis
Management of emergency care, Educational Purpose (only if useful for a systematic review or synthesis)

Zakaria Zitoune ORCID logo1BCDEF, Luc Kugener ORCID logo2EF, Joop Jonckheer ORCID logo3EF, Katrien Lanckmans ORCID logo4BCD, Philippe Hantson ORCID logo5EF, Jacques Devriendt ORCID logo6EF, Patrick M. Honore ORCID logo1ABCDEF
DOI: 10.12659/AJCR.939884

Am J Case Rep In Press; DOI: 10.12659/AJCR.939884 The complete signature will be given at the time of publication

Available online: 2023-07-05, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract
BACKGROUND
Tricyclic antidepressant (TCA) drugs are a common cause of fatal poisoning because of their cardiotoxic and arrhythmogenic effects. Classic supportive management includes sodium bicarbonate, gastrointestinal chelating agents, and vasopressors. Recently, intravenous lipid emulsion (supported by a low evidence level) has also been used.
CASE REPORT
We report the case of a 55-year-old woman admitted to our Intensive Care Unit (ICU) with acute imipramine self-poisoning. She arrived at the emergency department 7 hours after imipramine ingestion; she had severe rhabdomyolysis upon admission, with creatine phosphokinase levels at about 52 500 IU/L (normal, <200 IU/L).
She quickly developed cardiogenic shock and malign arrhythmia requiring veno-arterial extra corporeal membrane oxygenation (VA-ECMO). Continuous renal replacement therapy (CRRT) with CytoSorb® (CytoSorbents, Monmouth Junction, New York, United Sates of America) was started 19 hours after admission. We performed serial blood measurements of imipramine and its active metabolite desipramine as well as viewing the levels on the CRRT-circuit monitor. Cardiac function improved and ECMO was explanted after 4 days. She also had severe acute respiratory distress syndrome, which resolved spontaneously. The neurologic outcome was favorable despite early myoclonus. The patient regained consciousness on the fifth day. Her clinical evolution was marked by acute ischemia of the lower left limb due to the arterial ECMO cannula.

CONCLUSIONS
These measurements document the efficacy of the CytoSorb® adsorber in removing a lipophilic drug from a patient’s bloodstream. To our knowledge, this is the first published case of CytoSorb® extracorporeal blood purification therapy for acute TCA poisoning.

https://amjcaserep.com/abstract/index/idArt/939884