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Literature Service
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February 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: a retrospective study looking at intraoperative use of CytoSorb in endocarditis patients, two case series - use of CytoSorb in adult septic shock patients and use of CytoSorb in pediatric septic shock patients, and an animal study looking at acute mycotoxin poisoning. 

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

  • Typhus and multiple organ failure
  • Infected pacemaker
  • Hyperinflammation post cardiac surgery
  • 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

Intraoperative hemoadsorption in patients with native mitral valve infective endocarditis
Haidari Z, Wendt D, Thielmann M, Mackowiak M, Neuhäuder M, Jakob H, Ruhparwar A, El Gabry M.
The Annals of Thoracic Surg 2020; epub
 
Summary
This retrospective non-randomized study included 58 consecutive patients with infective endocarditis of the native mitral valve who were undergoing surgery between January 2014 and July 2018. Thirty patients who received intraoperative CytoSorb therapy were compared to 28 patients who didn’t. The two groups of patients were comparable in their baseline characteristics prior to surgery. Results showed that postoperative sepsis occurred in only 5 patients in the CytoSorb (hemoadsorption) group and in 11 patients in the control group (p=0.05).  There were no sepsis-associated deaths in the CytoSorb group, whereas five septic patients died in the control group (p=0.02). Thirty-day-mortality was 10% in the hemoadsorption group versus 18% in the control group (statistically non-significant). Patients in the CytoSorb group also showed greater hemodynamic stability (less need for norepinephrine and epinephrine). The authors conclude that the data suggest that intraoperative hemoadsorption with CytoSorb may improve surgical outcome in patients with mitral valve endocarditis.

Link to Article

Publication

Experience with hemoadsorption (CytoSorb) in the management of septic shock patients.
Mehta Y, Mehta C, Kumar A, George JV, Gupta A, Nanda S, Kochhar G, Raizada A.
World J Crit Care Med 2020 9(1): 1 - 12
 
Summary
This retrospective case series included 100 adult patients who were admitted to intensive care between 2016 and 2018 in an Indian hospital following the diagnosis of sepsis or septic shock, who had been treated with dialysis and CytoSorb combination therapy. The authors used a new CytoSorb scoring (CS) system that was developed by a group of Indian clinicians for initiating CytoSorb therapy on the basis of their practical experience so far. The scoring system was derived from five parameters (hemodynamic, renal, respiratory, lab and sepsis scores), representing five different organ system which get affected in sepsis patients. This study proposes that the CytoSorb therapy should be recommended to the patients with scores between 8-13. In summary, results showed a reduction in the vasopressor dose, a significant reduction in cytokine levels, remarkable reduction in diagnostic markers such as PCT, CRP, bilirubin and serum lactate after the usage of CytoSorbtherapy. Early (preferably within <48 h after onset of septic shock) initiation could result in better clinical outcomes. CytoSorb was found to be safe and a well-tolerated rescue therapy option in patients with septic shock.

Link to Article

Publication

Hemoperfusion with Cytosorb in pediatric patients with septic shock: A retrospective observational study.
Bottari G, Guzzo I, Marano M, Stoppa F, Rava L, Di Nardo M, Cecchetti C.
Int J Artif Organs 2020; epub
 
Summary
This retrospective case series included eight consecutive pediatric patients who received CytoSorb with standard Continuous Renal Replacement Therapy (CRRT) within 24 hours of proven or suspected septic shock refractory to standard treatment. The ages of the children ranged from 1-13 years, and weight from 10-45 kg. The source of the septic shock included three with secondary hemophagocytic lymphohistopcytosis. Four of patients also received extracorporeal membrane oxygenation (3 VA-ECMO, 1 VV-ECMO). The Vasoactive-Inotropic Score (VIS) was measured before and after CytoSorb treatment. Time course of cytokines IL-6, IL-10, and tumor necrosis factor-alpha (TNFa) were measured at time 0, then every 12 h until the end of blood purification treatment (72 or 96 h). CytoSorb use with CRRT was associated with a rapid and significant decrease in catecholamine demand and hemodynamic stabilization with an improved VIS following CytoSorb (pre: 40.00 post: 8.89 p=0.0076). Overall the pediatric intensive care unit survival was 88.75%. Measurement of cytokine levels showed a significant reduction of IL-6 (7977.27-210.18 pg/mL, p=0.0077) and IL-10 (from 687.19 to 36.95 pg/mL, p=0.0180). There were no adverse events noted during the use of CytoSorb therapy.

Link to Pubmed

Publication

Hemoadsorption Improves Survival of Rats Exposed to an Acutely Lethal Dose of Aflatoxin B1
Ruggeberg KG, O’Sullivan P, Kovacs TJ, Dawson K, Capponi VJ, Chan PP, Golobish TD, Gruda MC.
Scientific Reports 2020; 10(1): epub
 
Summary
Mycotoxins, including aflatoxin B1 (AFB1), are highly toxic, causing a severe inflammatory reaction, and pose a serious threat as biological weapons due to their easy accessibility and lack of effective therapeutics. This study investigated whether CytoSorb (CS) could improve survival in rats after a lethal aflatoxin dose. The rats received a lethal dose of AFB1 intravenously and hemoperfusion with CytoSorb or a control device was initiated immediately, or after 30, 90, or 240-minute delays, and then conducted for 4 hours. It was found that CytoSorb removes AFB1 from the circulation and significantly improves survival when initiated within 90 minutes of toxin administration. It is known that CytoSorb also removes damage associated molecular patterns (DAMPS), which, together with the reduction in inflammatory mediators, may be an additional aspect that helps to explain the reduction of associated tissue damage, and the observed survival benefit. The authors suggest that CytoSorb could be a viable countermeasure against acute mycotoxin exposure.

Link to Pubmed

Case of the Week 05 / 2020

Use of CytoSorb in a patient diagnosed with sepsis and MODS due to infection with Salmonella typhi
Chhabra M, Chhabra, SC, Singh YP, Negi A.
Max Super Speciality Hospital, Patparganj, Delhi, India

Summary
This case reports on a 19-year-old male patient, who was admitted to the emergency department of the Max Hospital Patparganj with a 4-5 day history of fever, vomiting, generalized weakness, and decreased appetite with poor food intake.

Link to full Case of the Week (pdf)

Case of the Week 06 / 2020

Use of CytoSorb in a patient with septic shock due to an infected cardiac pacemaker
Niederalt G, Schmid S, Happ N.
Clinic and Policlinic for Internal Medicine I, University Hospital Regensburg, Germany

Summary
This case reports on a 67-year-old male patient (known pre-existing conditions: chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), morbid obesity with a BMI of 34.9), who was transferred from a peripheral hospital to the University Hospital Regensburg with septic shock after explantation of an infected pacemaker

Link to full Case of the Week (pdf)

Case of the Week 07 / 2020

Use of CytoSorb hemadsorption in the management of hyperinflammation post CABG surgery following acute cardiac failure accompanied by pulmonary infection
Mahant TS*, Sahoo M#, Dhaliwal VS#. 
*Department of Cardiothoracic Surgery & Vascular Surgery 
#Department of Cardiac Anaesthesia,
Fortis Hospital, Mohali, Chandigarh, India


Summary 
This report describes the case of a 73-year-old male patient who presented to the hospital with a 7-day history of intermittent fever and cough with expectoration as well as complains about pain and swelling on his right side for two days.

Link to full Case of the Week (pdf)

Case of the Week 08 / 2020

Use of CytoSorb in a patient with septic shock in necrotising fasciitis
Schmidt M, Heuer B, Glar C.
Anesthesiological Intensive Care Unit, Hospital Barmherzige Brüder Trier, Germany

Summary
This case reports on a 68-year-old patient who presented in the emergency department with phlegmonous skin alterations and pain in the right lower leg, fever (39.7°C) as well as tachypnea (respiratory rate 31/min).

Link to full Case of the Week (pdf)
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