Abstract
Systemic inflammation is a key characteristic of sepsis but also also in non-infectious conditions such as post-cardiac arrest syndrome. Cytokine adsorption and extracorporeal membrane oxygenation are emerging therapies applied in these critically ill patients, but the experience with their concurrent use is limited. We evaluated cytokine adsorption in critically ill patients requiring support with either veno-venous (vv) or veno-arterial (va) extracorporeal membrane oxygenation (ECMO) support and hypothesized that adsorber incorporation into the ECMO circuit was technically feasible and not associated with imminent risk. We analyzed data from the first six cases of a prospective single-center registry of patients undergoing veno-venous (vv) or veno-arterial (va) ECMO therapy. While in most published cases cytokine adsorbers were inserted into a hemofiltration circuit, we directly incorporated the adsorber into the ECMO circuit without interruption of continuous ECMO support. We observed no relevant side effects attributable to cytokine adsorption. Thirty-day mortality was 83% (predicted mortality 87%), indicating that the decision for adding cytokine adsorption may have been considered as an ultima ratio decision in severe cases with poor prognosis. Vasopressor or inotrope use, lactate level, and fluid balance did not change significantly when comparing pre- vs. post-cytokine adsorption values. Interestingly, the real-time course of the mentioned three surrogate parameters remained unaltered in all but two cases, regardless of cytokine removal. Beneficial effects of cytokine adsorption are plausible in two va-ECMO-treated patient, where increasing lactate began to drop after initiation of cytokine adsorption. Taken together, these data suggest that incorporation of cytokine adsorption into the management of critically ill patients requiring continued ECMO support is feasible and easy to handle. Whether cytokine removal improves clinical outcome in ECMO-treated patients should now be investigated in randomized controlled trials.
Highlights
Sepsis is one of the leading causes for mortality and persistent impairment world-wide [1, 2] and new therapeutic approaches are highly needed
We present a series of six cases from a single-center registry of patients treated with venovenous (vv) or venoarterial extracorporeal membrane oxygenation (ECMO) therapy at the 30-bed medical intensive care unit of the Department of Medicine III (Interdisciplinary Intensive Care), Medical Center, University of Freiburg and Heart Center Freiburg University between July 2015 and April 2017
We identified six patients in our registry that received cytokine adsorption while undergoing ECMO therapy for septic shock (n = 4) or after cardiac arrest (n = 2) (Figure 2)
Summary
Sepsis is one of the leading causes for mortality and persistent impairment world-wide [1, 2] and new therapeutic approaches are highly needed. A hallmark of sepsis is the systemic inflammatory response. It is characterized by increased release of damage-associated molecular patterns (DAMPs) and unbalanced activation of the innate immune system [3]. Excessive secretion of pro-inflammatory cytokines is considered as one major driver of early mortality in sepsis by mediating capillary leakage and hemodynamic instability [3]. Cytokine adsorption has been proposed as a new approach to target systemic inflammation [3]. CytoSorb has already entered clinical application [7] and randomized clinical trials on sepsis, pancreatitis (clinicaltrials.gov NCT03082469) or heart surgery (clinicaltrials.gov NCT02265419) are ongoing
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
