Sequential Extracorporeal Therapy of Pathogen Removal Followed by Cell-Directed Extracorporeal Therapy in Streptococcal Toxic Shock Syndrome Refractory to Venoarterial Extracorporeal Membrane Oxygenation: A Case Report

Extracorporeal multi-organ support: ECMO, CRRT, and hemoperfusion for acute alcohol intoxication with renal and respiratory failure

INTRODUCTION

Acute alcohol intoxication can lead to severe complications, including acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), and systemic inflammatory response syndrome (SIRS). Conventional treatments often fail to stabilize critically ill patients, necessitating advanced extracorporeal life support. This study evaluates the effectiveness of extracorporeal membrane oxygenation (ECMO) combined with continuous renal replacement therapy (CRRT) and hemoperfusion (HP) in managing multi-organ failure after acute alcohol intoxication.

METHODOLOGY

A critically ill patient with alcohol-induced esophageal perforation, ARDS, and AKI was treated with ECMO, CRRT, and HP after conventional therapies proved insufficient. CRRT was used for fluid management and renal support, while HP facilitated cytokine removal to mitigate inflammation. The clinical course was monitored using respiratory parameters, renal function markers, inflammatory cytokine levels, and hemodynamic stability.

RESULTS

The combination therapy improved oxygenation, stabilized renal function, and reduced systemic inflammation. The patient successfully underwent surgical repair for esophageal perforation and showed full recovery at two-year follow-up.

CONCLUSION

Integrating CRRT and HP into ECMO circuits offers a novel and effective approach for managing renal dysfunction in acute alcohol intoxication. This strategy may improve outcomes in critically ill patients requiring extracorporeal support. Further studies are needed to optimize its clinical application.

[Extracorporeal removal of pathogens using a biomimetic adsorber-A new treatment strategy for the intensive care unit : Seraph® 100 Microbind® Affinity Blood Filter and its fields of application]

BACKGROUND

In 2019 the World Health Organization (WHO) listed antimicrobial resistance among the top 10 threats to global health. The Seraph® 100 Microbind® Affinity blood filter (Seraph® 100) has been in use since 2019 to eliminate pathogens from the bloodstream in addition to anti-infective pharmacotherapy. It is the first device used to rapidly and efficiently reduce the number of circulating bacteria and viruses.

OBJECTIVE

After a background on the concept of extracorporeal pathogen removal in general, this review summarizes the preclinical and clinical data on the Seraph® 100 Affinity Blood Filter. The clinical effect of this treatment and potential therapeutic options are described.

METHODS

Structured PubMed review including references published up to February 2024.

RESULTS

Case reports, uncontrolled observational studies and data from registries show widespread clinical use of the Seraph® 100 ranging from difficult to treat bacterial (super) infections to viral infections. The treatment can be done as stand-alone hemoperfusion or in combination with all forms of kidney replacement therapy as well as in extracorporeal membrane oxygenation.

CONCLUSION

The use of the Seraph® 100 varies in terms of duration, concomitant therapy and clinical settings. Due to the absence of prospective controlled trials the clinical effect cannot be properly evaluated.