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Literature Service
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May 2020

<<Briefanrede>> <<Last Name/Nachname>>,

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 short case series looking at elimination of glycopeptides with CytoSorb and the use of CytoSorb in organ donation; pediatric dengue fever case report; and a short review looking at the use of extracorporeal hemoadsorption in COVID-19 patients. 

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

  • Severe COVID-19 associated ARDS (two cases)
  • Septic shock post pancreatic resection
  • Necrotizing fasciitis

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

First experiences of hemoadsorption in the Donation after Circulatory Death
Baroni S, Melegari G, Brugioni L, Gualdi E, Barbieri A, Bertellini E.
Clinical Transplant 2020; epub
 
Summary
In this letter to the editor, the authors describe a recent new application of the use of CytoSorb with extracorporeal membrane oxygenation (ECMO) in cases of Donation after Circulatory Death (DCD). Particular to Italy, determination of death requires a 20-minute flat electrocardiogram, resulting in absence of circulation and any subsequent “Warm Ischemia Time (WIT)”, which  results in high levels of cytokines, such as Tumor Necrosis Factor-Alpha (TNFα). This is a case report of three DCD donors. The abdominal organs were re-perfused using normothermic regional perfusion (nRP) in combination with CytoSorb (included in the side arm of the regional ECMO circuit) in an attempt to increase the number of organs suitable for transplantation (liver and kidneys). Kidneys and liver were re-perfused with a blood flow always higher than 3 L/min, while blood flow through CytoSorb was 300ml/min during extracorporeal circulation. Blood sampling from the circuit showed a significant removal of TNFα by CytoSorb. During the first week after transplantation the creatinine serum mean value was almost 1.0 mg/dl, bilirubin 3.0 mg/dl, INR 1.2, only  serum transaminase reached value upper 2000 U/L followed by physiological decrease. No cases of liver or kidney graft syndrome or recipient death at day 30 were reported.
The authors state that nRP in combination with CytoSorb has the potential to limit irreversible organ damage, to restore organ function and to be used as a bridge to transplantation, potentially mitigating cytokine release and harmful inflammatory mediators, especially TNFα, thereby reducing the risk of any adverse scenarios or graft dysfunction.

Link to Pubmed

Publication

Elimination of glycopeptide antibiotics by cytokine hemoadsorption in patients with septic shock: A study of three cases
Dimski T, Brandenburger T, MacKenzie C, Kindgen-Milles D.
Int J Artif Organs: 2020; epub
 
Summary
In this short case series, glycopeptide antibiotic serum levels (vancomycin and teicoplanin) of three patients were measured pre and post CytoSorb adsorber which was inserted into a hemodialysis circuit in hemoperfusion mode in all cases for one 8 hour cycle. All patients had septic shock and were critically ill. In two patients, teicoplanin and vancomycin were given via a 60-min infusion and, in the third patient vancomycin was given via a continuous infusion. Results for the short infusions (60 min bolus), showed that both vancomycin and teicoplanin were removed immediately by the adsorber. However, the adsorptive capacity of the device was saturable with serum levels of vancomycin, but not teicoplanin, decreasing to subtherapeutic levels. With the continuous infusion of vancomycin, removal was less and serum levels remained in the therapeutic range. After 240 mins a difference between pre and post adsorber concentrations was not detectable. This information shows that the dose of these antibiotics should be adjusted appropriately, and early therapeutic drug monitoring is highly recommended. The authors suggest administering these antibiotics at the upper limit of recommended dosing regimens. Vancomycin should be administered as a high loading dose followed by a continuous infusion. The adsorptive capacity of the device (for the investigated substances) seems limited and saturation occurs within 120– 240 min.

Link to Pubmed

Publication

Extracorporeal Hemoadsorption: An option for COVID-19 associated Cytokine Storm syndrome
Napp LC & and Bauersachs J
Shock 2020; epub

Summary
In this short article the authors describe the immense challenges intensive care units are facing with the recent coronavirus SARS-CoV-2 pandemic, with hypoxic lung failure, acute heart failure and cytokine storm being the major determinants of an often fatal outcome. Recently it has been suggested that patients be screened for the cytokine storm by monitoring elevated levels of interleukin (IL)-6, IL-8 and tumor necrosis factor, as well as for the secondary form of hemophagocytic lymphohistiocytosis (HLH) by calculating the H-score. Anti-inflammatory interventions with specifc antibodies (e.g. against the IL-6 receptor), are currently evaluated, however, many aspects of the hyperinflammation caused by this novel disease are still unknown. To this end, the authors describe extracorporeal hemoadsorption, specifically CytoSorb, for COVID-19 associated cytokine storm syndrome. As they point out, CytoSorb has already been successfully used in various conditions with hyperinflammation including HLH. The authors state that there is also a reasonable chance that CytoSorb adsorbs the molecular motifs of the virus itself (pathogen associated molecular patterns) thereby limiting the cytokine storm rather than actively targeting individual pathways during inflammation. Finally, the authors consider it reasonable to employ hemoadsorption in selected COVID-19 patients with cytokine storm before prospective data is available, given the immense dynamics of disease, the pre-existing experiences in other conditions, and the devastating mortality of complicated cases.  
       

Link to Pubmed

Publication

Paediatric patient with dengue fever and associated multi-organ dysfunction syndrome (MODS) receiving hemoadsorption using Cytosorb®; A case report on clinical experience
Kumar S, Damera S.
IJMDAT 2020; 3: e233
 
Summary
In this case report a 10 year old patient with dengue haemorrhagic fever and systemic inflammatory response syndrome was admitted to hospital. He also had acute fulminant hepatic failure, with encephalopathy and oliguria. Despite liver protective measures (N-Acetyl Cystine infusion), his liver function and other organs became increasingly worse so CytoSorb was initiated on day 3 of admission. The adsorber was inserted in a post dialyser position  in hemodiafiltration mode with a blood flow of 40 ml/min without anticoagulation for a total of 18 hours. After this time his liver function including bilirubin levels improved (7.2 – 4.8 mg/dL). Over five days his platelet count increased from 17,000 to 108,000 (per L). His condition continued to improve, and he was eventually discharged in a stable condition. CytoSorb along with standard care is described as a safe and advantageous extracorporeal therapy option for paediatric dengue patients with multiple organ dysfunction. 

Link to Article

Case of the Week 19 / 2020

Use of CytoSorb in a patient with septic shock after anastomosis insufficiency with abscess following pancreatic resection
Mihalikova A.
Clinic for Anesthesiology and Intensive Care, Zeisigwaldkliniken Bethanien Chemnitz, Germany

Summary
This case reports on a 76-year-old male patient, who was admitted to the emergency department two weeks after an elective and initially complication-free pancreas resection with acute abdomen, signs of shock, and progressive somnolence.

Link to full Case of the Week (pdf)

Case of the Week 20 / 2020

Use of CytoSorb in a patient with necrotising fasciitis and septic shock 
Mesaric G. 
Department for Anesthesiology and Intensive Care Medicine, Feldbach-Fürstenfeld State Hospital, Austria

Summary
This case reports on a 73-year-old male patient (known pre-existing conditions: arterial hypertension) who was hospitalized with fatigue, dyspnea and severe pain in his left shoulder.

Link to full Case of the Week (pdf)

Case of the Week 21 / 2020

Use of CytoSorb in a patient with severe ARDS following COVID-19 infection
Montesinos MG, Perez AO.
Department of Intensive Care Medicine, Navarra Hospital Complex, Spain

Summary
This case reports on a 51-year-old male patient with a history of transient ischemic attack (TIA) and hypertension, who was admitted to the Emergency Department of the Navarra Hospital Complex in context of the COVID-19 outbreak.

Link to full Case of the Week (pdf)

Case of the Week 22 / 2020

Use of CytoSorb in severe ARDS after COVID-19 infection
Vogt A.
University Hospital and Polyclinic for Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, University Hospital Halle (Saale), Germany

Summary 
This case reports on a 65-year-old male patient (pre-existing chronic obstructive pulmonary disease, nicotine abuse with a total of 30-pack-years, and history of spontaneous pneumothorax in 2004) who was transferred from an external hospital to the University Hospital of Halle with proven COVID-19 infection and severe Acute Respiratory Distress Syndrome (ARDS).

Link to full Case of the Week (pdf)
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