Bruenger Frank, Kizner Lukasz, Weile Jan, Morshuis Michael, Gummert Jan F
1 Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen - Germany.
Int J Artif Organs. 2015 Feb;38(2):113-6. doi: 10.5301/ijao.5000382. Epub 2015 Feb 3.
A new hemoadsorption device intended as adjunctive treatment for patients with elevated cytokine levels in the setting of SIRS and sepsis has shown promising results. We report on the beneficial application of the device in a patient with cardiogenic septic shock receiving combined extracorporeal life support with rECMO, LVAD, and CVVH despite his highly septic condition.
A 39-year-old patient presented with fulminant ARDS and cardiogenic septic shock. A veno-arterial ECMO was implanted for circulatory support. During the course of illness, the patient developed acute renal failure in addition to his chronic renal insufficiency, making initiation of CVVH necessary. Due to a complete cardiac arrest in both ventricles, a left ventricular assist device (LVAD) in combination with right ECMO (rECMO) was implanted despite manifest septic conditions. In the post-operative course IL-6 levels and vasopressor dosages increased drastically. A CytoSorb hemoadsorption device was therefore installed in the CVVH circuit and 3 sessions were run during the following 4 days.
During CytoSorb treatment, inflammatory markers IL-6, procalcitonin, and C-reactive protein decreased concomitant with significantly reduced vasopressor support. No adverse device-related side effects were documented during or after the treatment sessions.
This is the first clinical case report of a highly septic patient treated with the combined use of LVAD, rECMO, CVVH, and CytoSorb. The combination was practical, technically feasible, and beneficial for the patient. This combination represents a reasonable approach to improve survival in patients with multiple organ dysfunction necessitating several organ supportive techniques.
一种新型血液吸附装置旨在作为全身炎症反应综合征（SIRS）和脓毒症患者细胞因子水平升高时的辅助治疗手段，已显示出有前景的结果。我们报告了该装置在一名心源性脓毒症休克患者中的有益应用，该患者尽管处于高度脓毒症状态，但仍接受了体外膜肺氧合（ECMO）、左心室辅助装置（LVAD）和持续静脉血液滤过（CVVH）的联合体外生命支持。
一名39岁患者出现暴发性急性呼吸窘迫综合征（ARDS）和心源性脓毒症休克。植入了静脉 - 动脉ECMO以提供循环支持。在病程中，患者除慢性肾功能不全外还出现了急性肾衰竭，因此有必要启动CVVH。由于双心室完全心脏骤停，尽管存在明显的脓毒症情况，仍植入了左心室辅助装置（LVAD）并联合右侧ECMO（rECMO）。术后病程中，白细胞介素 - 6（IL - 6）水平和血管升压药剂量急剧增加。因此，在CVVH回路中安装了CytoSorb血液吸附装置，并在接下来的4天内进行了3次治疗。
在CytoSorb治疗期间，炎症标志物IL - 6、降钙素原和C反应蛋白下降，同时血管升压药支持显著减少。治疗期间及治疗后均未记录到与装置相关的不良副作用。
这是首例关于一名高度脓毒症患者联合使用LVAD、rECMO、CVVH和CytoSorb进行治疗的临床病例报告。这种联合治疗方法实用、技术上可行且对患者有益。这种联合治疗代表了一种合理的方法，可提高需要多种器官支持技术的多器官功能障碍患者的生存率。
