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Thorac Cardiovasc Surg 2021; 69(03): 246-251
DOI: 10.1055/s-0040-1708479
Original Thoracic

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

Ali Akil
1   Department of Thoracic Surgery and Lung Support, Klinikum Ibbenbueren, Ibbenbueren, Germany
,
Stephan Ziegeler
2   Department of Anesthesiology, Intensive Care Medicine and Pain Management, Klinikum Ibbenbueren, Ibbenbueren, NRW, Germany
,
Jan Reichelt
1   Department of Thoracic Surgery and Lung Support, Klinikum Ibbenbueren, Ibbenbueren, Germany
,
Stephanie Rehers
2   Department of Anesthesiology, Intensive Care Medicine and Pain Management, Klinikum Ibbenbueren, Ibbenbueren, NRW, Germany
,
Omer Abdalla
1   Department of Thoracic Surgery and Lung Support, Klinikum Ibbenbueren, Ibbenbueren, Germany
,
Michael Semik
1   Department of Thoracic Surgery and Lung Support, Klinikum Ibbenbueren, Ibbenbueren, Germany
,
Stefan Fischer
3   Department of Thoracic Surgery and Lung Support, Ibbenbueren General Hospital, Ibbenbueren, Germany
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Abstract

Background High morbidity and mortality are frequently reported in intensive care patients suffering from severe sepsis with systemic inflammation. With the development of severe respiratory failure, extracorporeal membrane oxygenation (ECMO) is often required. In this study, cytokine adsorption therapy in combination with ECMO is applied in patients with acute respiratory distress syndrome (ARDS) due to severe pneumogenic sepsis. The efficacy of this therapy is evaluated compared with a historical cohort without hemoadsorption therapy.

Methods Between January and May 2018, combined high-flow venovenous ECMO and CytoSorb therapy (CytoSorb filter connected to ECMO circuit) was applied in patients (n = 13) with pneumogenic sepsis and ARDS. These patients were prospectively included (CytoSorb group). Data from patients (n = 7) with pneumogenic sepsis and ECMO therapy were retrospectively analyzed (control group).

Results All patients survived in the CytoSorb group, where the 30-day mortality rate reached 57% in the control group. After CytoSorb therapy, we instantly observed a significant reduction in procalcitonin (PCT) and C-reactive protein (CRP) levels compared with the control group. Within 48 hours, the initial high doses of catecholamine could be weaned off only in the CytoSorb group.

Conclusions Our results indicate that CytoSorb in combination with ECMO is an effective therapy to prevent escalation of sepsis with rapid weaning off high-dose catecholamine infusions and quick reduction in PCT and CRP levels. Optimal timing of immunomodulatory therapy and impact on ECMO-related inflammation still need to be furtherly investigated.

Keywords

extracorporeal membrane oxygenation - ECMO - inflammation - systemic; including cells - mediators - shock; systemic - cardiac - or circulatory


Publication History

Received: 04 August 2019

Accepted: 24 January 2020

Article published online:
06 April 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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