Sage Journals: Discover world-class research

Abstract

Introduction:

The acute surgical treatment of infective endocarditis (IE) carries a high risk of postoperative mortality. Most complications are linked to uncontrolled sepsis and inflammatory processes. Cytokine haemoadsorption is an extracorporeal technique which has benefits reported in haemodynamic stability and inflammatory response.

Case Report:

A 46-year-old male patient underwent emergency cardiac surgery due to progressive IE. Postcardiotomy cardiogenic shock associated with cardiac surgery required the implantation of venoarterial (VA)-ECMO. Three days later, the patient developed secondary septic shock. The novel application of continuous CytoSorb^TM treatment installed in the VA-ECMO circuit is demonstrated in this case during the management of simultaneous shocks. Advanced intensive care led to an improvement in the patient’s condition, which facilitated successful weaning from mechanical ventilation. However, the patient died from a new onset fulminant septic shock two months after his initial cardiac surgery.

Discussion:

VA-ECMO is suitable for installation of the CytoSorb^TM cartridge. This modality could be an option for high-volume, continuous cytokine haemoadsorption when VA-ECMO is employed without renal replacement therapy.

Conclusion:

This specific application of CytoSorb^TM was safe, feasible and contributed to the optimal management of simultaneous shocks.

Keywords

haemoadsorption CytoSorb ECMO post-cardiotomy cardiogenic shock septic shock

Get full access to this article

View all access options for this article.

References

Mirabel

Sonneville

Hajage

et al . Long-term outcomes and cardiac surgery in critically ill patients with infective endocarditis. Eur Heart J 2014; 35: 1195–1204.

Patrat-Delon

Rouxel

Gacouin

et al . EuroSCORE II underestimates mortality after cardiac surgery for infective endocarditis. Eur J Cardiothorac Surg 2016; 49: 944–951.

Abegaz

Bahagavathula

Gebreyohannes

et al . Short- and long-term outcomes in infective endocarditis patients: a systematic review and meta-analysis. BMC Cardiovasc Disord 2017; 17: 291.

Uhle

Chousterman

Grützmann

et al . Pathogenic, immunologic, and clinical aspects of sepsis – update 2016. Rev Anti Infect Ther 2016; 14: 917–927.

Kellum

Song

Venkataraman

. Hemoadsorption removes tumor necrosis factor, interleukin-6, and interleukin-10, reduces nuclear factor-κB DNA binding, and improves short-term survival in lethal endotoxemia. Crit Care Med 2004; 32: 801–805.

Kellum

Venkataraman

Powner

et al . Feasibility study of cytokine removal by hemoadsorption in brain-dead humans. Crit Care Med 2008; 36: 268–272.

Peng

Carter

Kellum

. Effects of hemoadsorption on cytokine removal and short-term survival in septic rats. Crit Care Med 2008; 36: 1573–1577.

Taniguchi

. Cytokine adsorbing columns. Contrib Nephrol 2010; 166: 134–141.

Frimmel

Schipper

Henschel

et al . First description of single-pass albumin dialysis combined with cytokine adsorption in fulminant liver failure and hemophagocytic syndrome resulting from generalized herpes simplex virus 1 infection. Liver Transpl 2014; 20: 1523–1524.

10.

van der Linde

Grootendorst

. First case of toxic shock treated with haemoadsorption by CytoSorb^® in the Netherlands. Neth J Crit Care 2016; 24: 27–29.

11.

Gruda

Ruggeberg

O‘Sullivan

et al . Broad adsorption of sepsis-related PAMP and DAMP molecules, mycotoxins, and cytokines from whole blood using CytoSorb^® sorbent porous polymer beads. PLoS ONE 2018; 13: e0191676.

12.

David

Thamm

Schmidt

BMW

et al . Effect of extracorporeal cytokine removal on vascular barrier function in a septic shock patient. J Intensive Care 2017; 5: 12.

13.

Hetz

Berger

Recknagel

et al . Septic shock secondary to β-hemolytic streptococcus-induced necrotizing fasciitis treated with a novel cytokine adsorption therapy. Int J Artif Organs 2014; 37: 422–426.

14.

Kogelmann

Jarczak

Scheller

et al . Hemoadsorption by CytoSorb in septic patients: a case series. Crit Care 2017; 21: 74.

15.

Mitzner

Gloger

Henschel

et al . Improvement of hemodynamic and inflammatory parameters by combined hemoadsorption and hemodiafiltration in septic shock: a case report. Blood Purif 2013; 35: 314–315.

16.

Friesecke

Stecher

Gross

et al . Extracorporeal cytokine elimination as rescue therapy in refractory septic shock: a prospective single-center study. J Artif Organs 2017; 20: 252–259.

17.

Houschyar

Pyles

Rein

et al . Continuous hemoadsorption with a cytokine adsorber during sepsis – a review of the literature. Int J Artif Organs 2017; 40: 205–211.

18.

Baumann

Buchwald

Annecke

et al . RECCAS - REmoval of Cytokines during CArdiac Surgery: study protocol for a randomised controlled trial. Trials 2016; 17: 137.

19.

Cerdá

Baldwin

Honore

et al . Role of technology for the management of AKI in critically ill patients: from adoptive technology to precision continuous renal replacement therapy. Blood Purif 2016; 42: 248–265.

20.

Bruenger

Kizner

Weile

et al . First successful combination of ECMO with cytokine removal therapy in cardiogenic septic shock: a case report. Int J Artif Organs 2015; 38: 113–116.

21.

Lees

Rosenberg

Hurtado-Doce

et al . Combination of ECMO and cytokine adsorption therapy for severe sepsis with cardiogenic shock and ARDS due to Panton–Valentine leukocidin—positive Staphylococcus aureus pneumonia and H1N1. J Artif Organs 2016; 19: 399–402.

22.

Träger

Schütz

Fischer

et al . Cytokine reduction in the setting of an ARDS-associated inflammatory response with multiple organ failure. Case Rep Crit Care 2016; 2016: 9852073.

23.

Marek

Gamper

Reining

et al . ECMO and cytokine removal for bridging to surgery in a patient with ischemic ventricular septal defect – a case report. Int J Artif Organs 2017; 40: 526–529.

Continuous cytokine haemoadsorption incorporated into a venoarterial ECMO circuit for the management of postcardiotomy cardiogenic and septic shock – a case report

Abstract

Introduction:

Case Report:

Discussion:

Conclusion:

Keywords

Get full access to this article

References