Combined Use of CytoSorb and ECMO in Patients with Severe Pneumogenic Sepsis

Akil, Ali; Ziegeler, Stephan; Reichelt, Jan; Rehers, Stephanie; Abdalla, Omer; Semik, M; Fischer, Stefan

doi:10.1055/s-0040-1708479

Cited by 63 publications

(93 citation statements)

References 19 publications

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“…Among survivors, vasopressor use decreased to 31.6% after 72 hours and to 26.3% after 96 hours compared to baseline. In accordance with previous studies [28,29,32,40,44] a rapid shock reversal was achieved (Fig. 5).…”

Section: Discussionsupporting

confidence: 92%

High-dose CytoSorb hemoadsorption is associated with improved survival in patients with septic shock: A retrospective cohort study

Schultz

Schwier

Eickmeyer

et al. 2021

Journal of Critical Care

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Background: Septic shock and SIRS are life-threatening diseases with persistent high mortality.Hemoadsorption with CytoSorb ® offers a possible therapeutic approach, but the optimal timing, dosing and indications are still unclear.Methods: Observational data from 70 patients with septic shock or SIRS, treated in a university hospital with hemoadsorption by CytoSorb ® in addition to renal replacement therapy were analyzed retrospectively. Physiologic parameters and clinical outcomes were extracted from the electronic charts. The predicted mortality was calculated based on APACHE II and SOFA scores and compared with the actual 28-day survival. The total amount of blood puri ed was correlated with outcome.Results: The main origins of septic shock were abdominal (n=29) or pulmonary (n=22). The mean age was 70.6±13.3 years. Hemoadsorption was applied for 85.6±53.8h with 3.2±1.7 cycles lasting 26.75±11.1h each. The severity was characterized by a mean APACHE II score of 30.2±6.3 and SOFA score of 13.8±3.5, which calculated to a predicted mortality of 73.3% and 62.1%, respectively. The observed mortality was signi cantly lower (35/70 patients (50%), p<0.05). Interleukin-6 levels at baseline were high (survivors: 7964±11242pg/ml; nonsurvivors: 8.755±15.800pg/ml, p=0.27) and decreased rapidly within 4-24h. Survival was independently associated with lower IL-6 levels and norepinephrine dosage after 24h. An increase in IL-6 after 48h was predictive of poor outcome.The treatment duration and amount of blood puri ed was higher in survivors than in non-survivors (8.47±4.42 vs. 6.07±3.57l/kg BW, p=0.017). We identi ed 3 clusters of <6l/kg, 6-13l/kg and ≥13l/kg BW with a linear dose-response relation between blood puri cation volume and survival. Although the predicted mortality was comparable among the clusters (p=ns), survival was best in the highest volume cluster (16.7%; p=0.045).Conclusions: The application of CytoSorb ® seems to be safe and effective in various conditions of septic shock and SIRS, although the optimal duration and dosing remain unclear. In a cohort of severely ill patients the observed mortality rate was lower than predicted and decreased linearly with blood puri cation volumes exceeding 6l/kg BW. These results suggest that hemoadsorption with CytoSorb ® improves survival in septic shock or SIRS, provided that the applied dose is high enough.

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Section: Discussionsupporting

confidence: 92%

High-dose CytoSorb hemoadsorption is associated with improved survival in patients with septic shock: A retrospective cohort study

Schultz

Schwier

Eickmeyer

et al. 2021

Journal of Critical Care

View full text Add to dashboard Cite

show abstract

“…after 96 hours compared to baseline. In accordance with previous studies [28,29,32,40,44] a rapid shock reversal was achieved (Fig. 5).…”

Section: Discussionsupporting

confidence: 92%

High-dose CytoSorb hemoadsorption is associated with improved survival in patients with septic shock: A retrospective cohort study

Schultz

Schwier

Eickmeyer

et al. 2020

Preprint

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Background: Septic shock and SIRS are life-threatening diseases with persistent high mortality. Hemoadsorption with CytoSorb® offers a possible therapeutic approach, but the optimal timing, dosing and indications are still unclear.Methods: Observational data from 70 patients with septic shock or SIRS, treated in a university hospital with hemoadsorption by CytoSorb® in addition to renal replacement therapy were analyzed retrospectively. Physiologic parameters and clinical outcomes were extracted from the electronic charts. The predicted mortality was calculated based on APACHE II and SOFA scores and compared with the actual 28-day survival. The total amount of blood purified was correlated with outcome.Results: The main origins of septic shock were abdominal (n=29) or pulmonary (n=22). The mean age was 70.6±13.3 years. Hemoadsorption was applied for 85.6±53.8h with 3.2±1.7 cycles lasting 26.75±11.1h each. The severity was characterized by a mean APACHE II score of 30.2±6.3 and SOFA score of 13.8±3.5, which calculated to a predicted mortality of 73.3% and 62.1%, respectively. The observed mortality was significantly lower (35/70 patients (50%), p<0.05). Interleukin-6 levels at baseline were high (survivors: 7964±11242pg/ml; nonsurvivors: 8.755±15.800pg/ml, p=0.27) and decreased rapidly within 4-24h. Survival was independently associated with lower IL-6 levels and norepinephrine dosage after 24h. An increase in IL-6 after 48h was predictive of poor outcome.The treatment duration and amount of blood purified was higher in survivors than in non-survivors (8.47±4.42 vs. 6.07±3.57l/kg BW, p=0.017). We identified 3 clusters of <6l/kg, 6-13l/kg and ≥13l/kg BW with a linear dose-response relation between blood purification volume and survival. Although the predicted mortality was comparable among the clusters (p=ns), survival was best in the highest volume cluster (16.7%; p=0.045).Conclusions: The application of CytoSorb® seems to be safe and effective in various conditions of septic shock and SIRS, although the optimal duration and dosing remain unclear. In a cohort of severely ill patients the observed mortality rate was lower than predicted and decreased linearly with blood purification volumes exceeding 6l/kg BW. These results suggest that hemoadsorption with CytoSorb® improves survival in septic shock or SIRS, provided that the applied dose is high enough.

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“…51 Useful therapeutic possibility of ECMO procedure is availability of cytokine absorption, that is, immunomodulators, which were previously shown to have positive effects in another group of critically ill patients with ARDS and sepsis. 52,53 One must underscore the fact that oxygen supplementation via mechanical ventilation and/or circulatory support are advanced methodologies of ICU treatment; however, those are still enhancers of acutely diminished body functions. In this way, machines are prolonging life, as a bridge to scarce potential that the patient self-recovers or by adding effective antiviral or other treatments that intervene in dominant pathogen life cycle.…”

Section: Oxygen Mechanical and Circulatory Supportmentioning

confidence: 99%

Novel coronavirus disease (COVID‐19) update on epidemiology, pathogenicity, clinical course and treatments

Boban

2020

Int J Clin Pract

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During the December of 2019, a series of patients with pneumonia caused by novel coronavirus; the severe acute respiratory syndrome (SARS) corona (COV‐2), that is, COVID‐19. Since the first cluster of cases was reported in China on 31 December 2019 until the 28 April 2020, there were internationally reported 3’000’000 cases, in over 185 countries, and 207'265 deaths. To date, it is still not unanimously clear which effects parameters of virus and host are important for the development of severe disease course. According to the most updated internationally available online cases register, COVID‐19 disease has mild symptoms in around 85% of cases, there are 3%‐10% of critical cases, and mortality is around 5%‐7%. Since currently there is no available vaccine and no well‐established specific antiviral therapy, numerous agents are being tested in clinical scenarios. The most common regimens include remdesivir, convalescent plasma. Widely used chloroquine, hydroxychloroquine and azithromycin combinations, as well as lopinavir‐ritonavir were shown to have less efficient treatment effects. More severe cases of pneumonia and dyspnoea, or uncontrollable fever are treated as inpatients, and nearly 10% in intensive care units. Oxygen supplementation is indicated to maintain peripheral blood oxygenation over 90%‐96%. Advanced support systems include mechanical ventilation and extracorporeal membranous support; however, those without targeted antiviral therapy represent only temporary bridge for scarce potential restitution in patient themselves. The aim of review is to present current state of the art in epidemiology, pathogenesis, clinical course and treatment of COVID‐19 patients.

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Combined Use of CytoSorb and ECMO in Patients with Severe Pneumogenic Sepsis

Cited by 63 publications

References 19 publications

High-dose CytoSorb hemoadsorption is associated with improved survival in patients with septic shock: A retrospective cohort study

High-dose CytoSorb hemoadsorption is associated with improved survival in patients with septic shock: A retrospective cohort study

High-dose CytoSorb hemoadsorption is associated with improved survival in patients with septic shock: A retrospective cohort study

Novel coronavirus disease (COVID‐19) update on epidemiology, pathogenicity, clinical course and treatments

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