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Combined Use of CytoSorb and ECMO in Patients with Severe Pneumogenic Sepsis
Background High morbidity and mortality are frequently reported in intensive care patients suffering from severe sepsis with systemic inflammation. With the development of severe respiratory failure, extracorporeal membrane oxygenation (ECMO) is often required. In this study, cytokine adsorption therapy in combination with ECMO is applied in patients with acute respiratory distress syndrome (ARDS) due to severe pneumogenic sepsis. The efficacy of this therapy is evaluated compared with a historical cohort without hemoadsorption therapy.
Methods Between January and May 2018, combined high-flow venovenous ECMO and CytoSorb therapy (CytoSorb filter connected to ECMO circuit) was applied in patients (n = 13) with pneumogenic sepsis and ARDS. These patients were prospectively included (CytoSorb group). Data from patients (n = 7) with pneumogenic sepsis and ECMO therapy were retrospectively analyzed (control group).
Results All patients survived in the CytoSorb group, where the 30-day mortality rate reached 57% in the control group. After CytoSorb therapy, we instantly observed a significant reduction in procalcitonin (PCT) and C-reactive protein (CRP) levels compared with the control group. Within 48 hours, the initial high doses of catecholamine could be weaned off only in the CytoSorb group.
Conclusions Our results indicate that CytoSorb in combination with ECMO is an effective therapy to prevent escalation of sepsis with rapid weaning off high-dose catecholamine infusions and quick reduction in PCT and CRP levels. Optimal timing of immunomodulatory therapy and impact on ECMO-related inflammation still need to be furtherly investigated.
Keywordsextracorporeal membrane oxygenation - ECMO - inflammation - systemic; including cells - mediators - shock; systemic - cardiac - or circulatory
Received: 04 August 2019
Accepted: 24 January 2020
06 April 2020 (online)
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- 1 Crowther MA, Marshall JC. Continuing challenges of sepsis research. JAMA 2001; 286 (15) 1894-1896
- 2 Singer M, Deutschman CS, Seymour CW. et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016; 315 (08) 801-810
- 3 Pranikoff T, Hirschl RB, Steimle CN, Anderson III HL, Bartlett RH. Efficacy of extracorporeal life support in the setting of adult cardiorespiratory failure. ASAIO J 1994; 40 (03) M339-M343
- 4 Millar JE, Fanning JP, McDonald CI, McAuley DF, Fraser JF. The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology. Crit Care 2016; 20 (01) 387
- 5 Träger K, Fritzler D, Fischer G. et al. Treatment of post-cardiopulmonary bypass SIRS by hemoadsorption: a case series. Int J Artif Organs 2016; 39 (03) 141-146
- 6 Song M, Winchester J, Albright RL, Capponi VJ, Choquette MD, Kellum JA. Cytokine removal with a novel adsorbent polymer. Blood Purif 2004; 22 (05) 428-434
- 7 Mitzner SR, Gloger M, Henschel J, Koball S. Improvement of hemodynamic and inflammatory parameters by combined hemoadsorption and hemodiafiltration in septic shock: a case report. Blood Purif 2013; 35 (04) 314-315
- 8 Bruenger F, Kizner L, Weile J, Morshuis M, Gummert JF. First successful combination of ECMO with cytokine removal therapy in cardiogenic septic shock: a case report. Int J Artif Organs 2015; 38 (02) 113-116
- 9 Friesecke S, Träger K, Schittek GA. et al. International registry on the use of the CytoSorb® adsorber in ICU patients: study protocol and preliminary results. Med Klin Intensivmed Notfmed 2019; 114 (08) 699-707
- 10 Houschyar KS, Pyles MN, Rein S. et al. Continuous hemoadsorption with a cytokine adsorber during sepsis - a review of the literature. Int J Artif Organs 2017; 40 (05) 205-211
- 11 Akil A, Reichelt J, Ziegeler S, Semik M, Fischer S. Combined use of cytokine adsorption therapy and extracorporeal membrane oxygenation (ECMO) in patients with severe pneumogenic sepsis and acute respiratory distress syndrome (ARDS). 27 th European Conference on General Thoracic Surgery; Dublin, Ireland 2019: 173-174
- 12 Tan M, Lu Y, Jiang H, Zhang L. The diagnostic accuracy of procalcitonin and C-reactive protein for sepsis: a systematic review and meta-analysis. J Cell Biochem 2019; 120 (04) 5852-5859
- 13 Becker KL, Snider R, Nylen ES. Procalcitonin assay in systemic inflammation, infection, and sepsis: clinical utility and limitations. Crit Care Med 2008; 36 (03) 941-952
- 14 Oberholzer A, Souza SM, Tschoeke SK. et al. Plasma cytokine measurements augment prognostic scores as indicators of outcome in patients with severe sepsis. Shock 2005; 23 (06) 488-493
- 15 Ding XF, Yang ZY, Xu ZT. et al. Early goal-directed and lactate-guided therapy in adult patients with severe sepsis and septic shock: a meta-analysis of randomized controlled trials. J Transl Med 2018; 16 (01) 331
- 16 Baumann A, Buchwald D, Annecke T, Hellmich M, Zahn PK, Hohn A. RECCAS - REmoval of Cytokines during CArdiac Surgery: study protocol for a randomised controlled trial. Trials 2016; 17 (01) 137
- 17 Morris C, Gray L, Giovannelli M. Early report: the use of Cytosorb™ haemabsorption column as an adjunct in managing severe sepsis: initial experiences, review and recommendations. J Intensive Care Soc 2015; 16 (03) 257-264
- 18 Friesecke S, Stecher SS, Gross S, Felix SB, Nierhaus A. Extracorporeal cytokine elimination as rescue therapy in refractory septic shock: a prospective single-center study. J Artif Organs 2017; 20 (03) 252-259
- 19 Kogelmann K, Jarczak D, Scheller M, Drüner M. Hemoadsorption by CytoSorb in septic patients: a case series. Crit Care 2017; 21 (01) 74
- 20 Träger K, Skrabal C, Fischer G. et al. Hemoadsorption treatment of patients with acute infective endocarditis during surgery with cardiopulmonary bypass - a case series. Int J Artif Organs 2017; 40 (05) 240-249
- 21 McILwain RB, Timpa JG, Kurundkar AR. et al. Plasma concentrations of inflammatory cytokines rise rapidly during ECMO-related SIRS due to the release of preformed stores in the intestine. Lab Invest 2010; 90 (01) 128-139