January 2020

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).

This month there are four new publications: two case series - use of CytoSorb in patients on extracorporeal life support and use of CytoSorb in patients with septic shock, and two case reports - use in a patient with candida infection and type 1 diabetes, and use in a pediatric patient with rhabdomyolysis. 

The cases of the week include the use of CytoSorb in patients with:

• Neuroleptic malignant syndrome and rhabdomyolysis
• Neutropenia, septic shock and multiple organ failure
• High thigh amputation after femoral artery occlusion
• Puerperal septic shock and multiple organ failure post cesarean section with permpartum cardiomyopathy
• Liver failure

For quick and easy access to the CytoSorb Literature Database, bookmark the following link: http://literature.cytosorb.com

Thank you very much for your interest. 
With kind regards from Berlin
 
Harriet Adamson
Senior Clinical Research Manager

Publication

Hemoadsorption treatment with CytoSorb in patients with ECLS therapy – a case series
Traeger K, Skrabal C, Fischer G, Schroeder J, Marenski L, Liebold A, Reinelt H, Datzmann T.
The Int J of Artif Organs 2019; epub

Summary
This retrospective case series described the use of extracorporeal life support (ECLS, specifically veno-arterial extracorporeal membrane oxygenation – VA ECMO) and CytoSorb hemoadsorption in 23 cardio-thoracic intensive care patients with a wide range of complex disease states. The trigger for initiation of CytoSorb was presence of renal replacement therapy (RRT) and the presence of one or more of the following - severe hyperinflammatory activation, severe reperfusion injury, extended cardiopulmonary bypass times with post-cardiotomy low cardiac output, and refractory vasoplegic response with rapid progressive organ dysfunction. The CytoSorb was integrated into the renal replacement therapy system, and patients had, on average 2 x 24 hour treatments (range 1-3). APACHE II and SOFA scores were high for these patients (28 and 13 respectively), representing a very severly sick patient population. Both interleukin (IL)-6 and IL-8 decreased pre and post CytoSorb as did procalcitonin (PCT). Patients stabilized hemodynamically, with a reduction in vasopressor requirements (epinephrine, norepinephrine) and a sustained mean arterial pressure (MAP). ECLS flow rate was maintained, and lactate, pH, and base excess could all be stabilized and normalized during and after the treatment period. The combination of CytoSorb hemoadsorption and RRT in ECLS patients appeared to be well tolerated  and there were no device related technical issues or adverse events during or after treatment.

Publication

Hemadsorption by extracorporeal cytokine adsorption therapy (CytoSorb) in the management of septic shock: A retrospective observational study
Singh YP, Chhabra SC, Lashkari K, Taneja A, Garg A, Chandra A, Chhabra M, Singh GP, Jain S.
The Int J Artif Organs 2019: epub
 
Summary
This retrospective, observational study included 36 patients with septic shock who also received CytoSorb therapy. After CytoSorb therapy there was a significant decrease in procalcitonin (PCT) within 24 hours of therapy. The leucocyte count also decreased within this time frame. The sepsis related organ failure assessment (SOFA) score decreased after the use of CytoSorb. Shock reversal was seen in 8 patients within 24 hrs of treatment. The authors confirm that CytoSorb may be a safe, effective and well tolerated rescue therapy, decreasing vasopressor requirements and stabilizing hemodynamics in septic shock patients.

Publication

Cytosorb for Management of Acute Kidney Injury due to Rhabdomyolysis in a Child.
Padiyar S, Deokar A, Birajdar S, Walawalkar A, Doshi H.
Indian Pediatr 2019; 56(11): 974-976
 
Summary
This is a case report of a previously healthy 6-year-old girl that presented with rhabdomyolysis following a febrile illness. Diagnostics revealed positive findings for Influenza B and enterovirus with very high serum creatine kinase (CK) and myoglobin levels (around 3,000 ng/ml). She developed myoglobinuria with oliguria leading to acute kidney injury so was put on intermittent and then continuous renal replacement therapy (CRRT) because of hemodynamic instability. A Cytosorb adsorber was added to remove the myoglobin and CK. After three days of CytoSorb her myoglobin had dropped to under 600 ng/ml and after two more days of CRRT she was able to be switched back to intermittent dialysis which she received until day 33. The patient was eventually discharged home. This is the first published case of the use of CytoSorb for removal of myoglobin in a pediatric patient. 

Publication

Cytokine adsorption as a promising option for septic shock and multiple organ failure due to Candida infection and decompensated type 1 diabetes mellitus
Klinkmann G, Stope MB, Meyer A.
Artif Organs 2019; epub
 
Summary
This is the case report of a 19 year old female patient with type 1 diabetes mellitus (T1DM) and candidiasis associated with severe metabolic acidosis who was admitted to the intensive care unit in septic shock with hemodynamic instability. Continuous renal replacement therapy (CRRT) was initiated in the first 24 hrs due to the metabolic acidosis (initial pH 6.69) and increased retention parameters. When she remained hemodynamically unstable despite high dose catecholamine therapy, and because of the significantly elevated interleukin(IL) -6 levels (>1000 pg/ml), a CytoSorb cartridge was inserted into the CRRT circuit for a 20 hr period. This resulted in a rapid improvement in her hemodynamics and resolution of the metabolic acidosis. The vasopressor support could be reduced during the treatment (norepinephrine 0.9 – 0.2 ug/kg/min). The hyperinflammation could also be rapidly controlled and all parameters reduced during the course of treatment (including procalcitonin and leukocytes). Treatment with CytoSorb was found to be safe and feasible without technical problems. Notably, this is the first case description reporting on the effects of CytoSorb in a patient with fungal septic shock and T1DM.

Case of the Week 46 / 2019

Use of CytoSorb in a patient with isolated liver failure  
Niederalt G, Schmid S, Happ N
Clinic and Policlinic for Internal Medicine I, University Hospital Regensburg, Germany

Summary
This case reports on a 54-year-old patient (known pre-existing conditions: state post hepatitis of unclear origin 2016, recent history of gout attack, allergy to penicillin), who was transferred from a peripheral hospital to the University Hospital Regensburg with acute liver failure.

Case of the Week 47 / 2019

Use of CytoSorb in a patient with puerperal septic shock and multiple organ failure following cesarean section with subsequent peripartum cardiomyopathy
Mehta C, Mehta Y
Medanta Institute of Critical Care and Anesthesiology, Medanta Hospital, Gurugram, Haryana, India

Summary
The following report describes the case of a 31-year-old female patient who was transferred from a peripheral hospital to the Medanta hospital with the diagnosis of peripartum cardiomyopathy.

Case of the Week 48 / 2019

Use of CytoSorb in a patient with emergency thigh amputation after femoral artery occlusion
Liewald J, Steinfeldt T
Intensive Care Unit, Diakonie-Hospital Schwäbisch Hall, Germany

Summary 
This case reports on a 59-year-old male patient (known medical history: nicotine and alcohol abuse, depression), who was transferred to the hospital via the emergency ambulance after he was found at home neglected and confused.

Case of the Week 49 / 2019

Combined application of CytoSorb and CRRT in a patient with acute renal failure and septic shock as a consequence of lower respiratory tract infection
Gupta A.
Max Super Specialty Hospital, Shalimar Bagh, India

Summary
This case reports on a 57-year-old female patient, who was transferred from a peripheral hospital to the emergency department of Max Super Specialty Hospital, Shalimar Bagh, with complaints of abdominal pain, breathlessness and fever over the previous 2 days.

Case of the Week 51 / 2019

Use of CytoSorb in a patient with neutropenia, septic shock and multiple organ failure
Gupta S. 
Narayana Super Specialty Hospital, Gurgaon, India

Summary
This case reports on a previously healthy 38-year-old male patient who was admitted to the emergency department of Narayana Super Specialty Hospital with fever, neutropenia and septic shock.

Case of the Week 04 / 2020

Use of CytoSorb in a patient with neuroleptic malignant syndrome, rhabdomyolysis and acute renal failure
Grazzi Bertazzi M*, La Rosa V#, Lanzafame B#, Scrofani G*, Lauretta D*, Spampinato A*, Sciuto O*, 
Sapienza D*, Gennaro M*
*Department of Anesthesia and Intensive Care, Cannizzaro Hospital, Catania, Italy
#Department of Anesthesia and Intensive Care, Poly Clinic, University Hospital, G Rodolico, Catania, Italy

Summary
This report describes the case of a 39-year-old female patient, who was admitted to the Emergency Department with psychomotor agitation (hyperactivity) and high fever (39°C).