Träger Karl, Skrabal Christian, Fischer Guenther, Schroeder Janpeter, Marenski Larissa, Liebold Andreas, Reinelt Helmut, Datzmann Thomas
Department of Cardiac Anesthesiology and Interdisciplinary Surgical Intensive Care, University Hospital Ulm, Ulm, Germany.
Clinic of Cardiothoracic and Vascular Surgery, University Hospital Ulm, Ulm, Germany.
Int J Artif Organs. 2020 Jun;43(6):422-429. doi: 10.1177/0391398819895287. Epub 2019 Dec 23.
Extracorporeal life support is an increasingly used technique for respiratory and cardiocirculatory support. Besides primary organ dysfunction, an excessive systemic hyperinflammatory response can be the underlying cause for acute organ failure necessitating extracorporeal life support therapy, or it may be associated with the extracorporeal life support itself. Controlling this overwhelming inflammatory response using CytoSorb hemoadsorption has been shown to be associated with improved hemodynamics and restored metabolic balance resulting in preserved organ functions.
In this retrospective case series, we describe 23 patients undergoing extracorporeal life support therapy and CytoSorb hemoadsorption. Cytokine levels were monitored, hemodynamic and metabolic variables were recorded, and outcome measures such as duration of organ support, intensive care unit mortality, and hospital mortality were noted.
CytoSorb treatment was associated with a trend toward a reduction in plasma cytokine levels (first treatment median interleukin-6 pre 595 vs post 350 pg/mL (n.s.); second treatment median interleukin-6 317 vs 108 pg/mL, p < 0.05), a reduced vasoplegic response resulting in a reduction in vasopressor requirements (first treatment median norepinephrine pre 0.15 vs post 0.02 µg/kg/min (n.s.); second treatment median norepinephrine 0.1 vs 0.02 µg/kg/min, p < 0.05) as well as rebalancing of deranged metabolic parameters (first treatment median lactate pre-treatment 6 vs post-treatment median lactate 2 mmol/L, p < 0.05). The hemoperfusion treatment was well tolerated and safe, without the occurrence of any CytoSorb device-related adverse events.
Hemoadsorption may offer a potentially promising therapeutic option for critically ill patients undergoing extracorporeal life support therapy, with cytokine reduction and a consecutively mitigated inflammatory response, decreased vasoplegia, and improved organ function as seen in our patients.
体外生命支持是一种越来越多地用于呼吸和心肺循环支持的技术。除了原发性器官功能障碍外，过度的全身炎症反应可能是需要体外生命支持治疗的急性器官衰竭的潜在原因，或者它可能与体外生命支持本身有关。已证明使用CytoSorb血液吸附控制这种压倒性的炎症反应与改善血流动力学和恢复代谢平衡相关，从而保留器官功能。
在这个回顾性病例系列中，我们描述了23例接受体外生命支持治疗和CytoSorb血液吸附的患者。监测细胞因子水平，记录血流动力学和代谢变量，并记录诸如器官支持持续时间、重症监护病房死亡率和医院死亡率等结局指标。
CytoSorb治疗与血浆细胞因子水平降低的趋势相关（第一次治疗白细胞介素-6中位数治疗前595 vs治疗后350 pg/mL（无统计学意义）；第二次治疗白细胞介素-6中位数317 vs 108 pg/mL，p <0.05），血管麻痹反应减轻导致血管升压药需求减少（第一次治疗去甲肾上腺素中位数治疗前0.15 vs治疗后0.02 μg/kg/min（无统计学意义）；第二次治疗去甲肾上腺素中位数0.1 vs 0.02 μg/kg/min，p <0.05）以及紊乱的代谢参数重新平衡（第一次治疗乳酸中位数治疗前6 vs治疗后乳酸中位数2 mmol/L，p <0.05）。血液灌流治疗耐受性良好且安全，未发生任何与CytoSorb装置相关的不良事件。
血液吸附可能为接受体外生命支持治疗的重症患者提供一种潜在的有前景的治疗选择，如我们的患者所示，可降低细胞因子水平并连续减轻炎症反应、减少血管麻痹并改善器官功能。
