Pieri Marina, Russo Giada, Francescon Claudia, Fominskiy Evgeny, Nardelli Pasquale, Calabrò Maria Grazia, Franco Annalisa, Fiorito Sara, Ajello Silvia, Scandroglio Anna Mara
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Int J Artif Organs. 2025 Jun;48(6):429-433. doi: 10.1177/03913988251339080. Epub 2025 May 16.
Severe rhabdomyolysis, characterized by extensive muscle breakdown and release of myoglobin and creatine kinase (CK), is a life-threatening condition often complicated by acute kidney injury (AKI) and multi-organ failure (MOF). Even when conventional treatments such as fluid resuscitation and renal replacement therapy (RRT) are timely applied, severe cases remain challenging to manage. Among therapies available in this setting, hemadsorption with CytoSorb has the potential not only to treat rhabdomyolysis through removal of circulating molecules but also to limit or even prevent rhabdomyolysis-related renal failure and MOF. In this case series we present a preliminary experience with a novel use CytoSorb hemoadsorption therapy, which encompassed the use of two CytoSorb cartridges running in parallel, to enhance myoglobin and cytokine clearance. Clinical data from the three patients with severe rhabdomyolysis treated with dual concomitant CytoSorb treatments highlighted marked improvements in CK, renal, hepatic, and inflammatory markers, with possible remarkable impact in containing rhabdomyolysis-related organ failure and death. Further investigation is warranted to establish the opportunity of tailored protocols for critically ill patients.
严重横纹肌溶解症以广泛的肌肉分解以及肌红蛋白和肌酸激酶(CK)释放为特征,是一种危及生命的病症,常并发急性肾损伤(AKI)和多器官功能衰竭(MOF)。即便及时应用了诸如液体复苏和肾脏替代疗法(RRT)等传统治疗方法,严重病例的处理依然具有挑战性。在此种情况下可用的治疗方法中,使用CytoSorb进行血液吸附不仅有可能通过清除循环分子来治疗横纹肌溶解症,还能限制甚至预防与横纹肌溶解症相关的肾衰竭和MOF。在本病例系列中,我们展示了一种新型使用CytoSorb血液吸附疗法的初步经验,该疗法包括并行使用两个CytoSorb柱,以增强肌红蛋白和细胞因子清除。三名接受双重同步CytoSorb治疗的严重横纹肌溶解症患者的临床数据显示,CK、肾脏、肝脏和炎症标志物有显著改善,对控制与横纹肌溶解症相关的器官衰竭和死亡可能有显著影响。有必要进行进一步研究,以确定为重症患者制定定制方案的机会。