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García-Villegas R, Arni S. Hemoadsorption in Organ Preservation and Transplantation: A Narrative Review. Life (Basel) 2023; 14:65. [PMID: 38255680 PMCID: PMC10817660 DOI: 10.3390/life14010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
Cytokine adsorption can resolve different complications characteristic of transplantation medicine, such as cytokine storm activation and blood ABO and immune incompatibilities. Cytokine adsorption is also performed for the treatment of various life-threatening conditions, such as endotoxic septic shock, acute respiratory distress syndrome, and cardiogenic shock, all potentially leading to adverse clinical outcomes during transplantation. After surgery, dysmetabolism and stress response limit successful graft survival and can lead to primary or secondary graft dysfunction. In this clinical context, and given that a major problem in transplant medicine is that the demand for organs far exceeds the supply, a technological innovation such as a hemoadsorption system could greatly contribute to increasing the number of usable organ donors. The objectives of this review are to describe the specific advantages and disadvantages of the application of cytokine adsorption in the context of transplantation and examine, before and/or after organ transplantation, the benefits of the addition of a cytokine adsorption therapy protocol.
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Affiliation(s)
- Refugio García-Villegas
- Departamento de Fisiología, Biofísica y Neurociencias, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, D.F., Mexico City 07360, Mexico;
| | - Stephan Arni
- Department of Thoracic Surgery, University Hospital Zürich, 8091 Zürich, Switzerland
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2
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Ke J, Wei Y, Chen B. Application of Hemoperfusion in the Treatment of Acute Poisoning. Blood Purif 2023; 53:49-60. [PMID: 37918359 DOI: 10.1159/000532050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/29/2023] [Indexed: 11/04/2023]
Abstract
Rescue of acute poisoning is a race against time, and it is particularly important to remove toxic substances in time. Traditional methods include gastric lavage, promoting elimination, chelating agents, and other treatments. Hemoperfusion is a common blood purification technique. In the clinical practice of acute poisoning, hemoperfusion can directly remove toxic substances through its unique adsorption effect, showing its excellent efficacy. This paper reviews the experience of hemoperfusion in the treatment of various drug overdoses, pesticides, biological toxins, and industrial poisons, even drug addiction. It is hoped to provide a reference for clinicians in acute poisoning rescue.
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Affiliation(s)
- Jianting Ke
- Department of Nephrology, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Yuting Wei
- Department of Nephrology, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Binhuan Chen
- Department of Nephrology, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
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3
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Hawchar F, Tomescu D, Träger K, Joskowiak D, Kogelmann K, Soukup J, Friesecke S, Jacob D, Gummert J, Faltlhauser A, Aucella F, van Tellingen M, Malbrain MLNG, Bogdanski R, Weiss G, Herbrich A, Utzolino S, Nierhaus A, Baumann A, Hartjes A, Henzler D, Grigoryev E, Fritz H, Bach F, Schröder S, Weyland A, Gottschaldt U, Menzel M, Zachariae O, Novak R, Berden J, Haake H, Quintel M, Kloesel S, Kortgen A, Stecher S, Torti P, Nestler F, Nitsch M, Olboeter D, Muck P, Findeisen M, Bitzinger D, Kraßler J, Benad M, Schott M, Schumacher U, Molnar Z, Brunkhorst FM. Hemoadsorption in the critically ill-Final results of the International CytoSorb Registry. PLoS One 2022; 17:e0274315. [PMID: 36282800 PMCID: PMC9595535 DOI: 10.1371/journal.pone.0274315] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/25/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of the current paper is to summarize the results of the International CytoSorb Registry. Data were collected on patients of the intensive care unit. The primary endpoint was actual in-hospital mortality compared to the mortality predicted by APACHE II score. The main secondary endpoints were SOFA scores, inflammatory biomarkers and overall evaluation of the general condition. 1434 patients were enrolled. Indications for hemoadsorption were sepsis/septic shock (N = 936); cardiac surgery perioperatively (N = 172); cardiac surgery postoperatively (N = 67) and "other" reasons (N = 259). APACHE-II-predicted mortality was 62.0±24.8%, whereas observed hospital mortality was 50.1%. Overall SOFA scores did not change but cardiovascular and pulmonary SOFA scores decreased by 0.4 [-0.5;-0.3] and -0.2 [-0.3;-0.2] points, respectively. Serum procalcitonin and C-reactive protein levels showed significant reduction: -15.4 [-19.6;-11.17] ng/mL; -17,52 [-70;44] mg/L, respectively. In the septic cohort PCT and IL-6 also showed significant reduction: -18.2 [-23.6;-12.8] ng/mL; -2.6 [-3.0;-2.2] pg/mL, respectively. Evaluation of the overall effect: minimal improvement (22%), much improvement (22%) and very much improvement (10%), no change observed (30%) and deterioration (4%). There was no significant difference in the primary outcome of mortality, but there were improvements in cardiovascular and pulmonary SOFA scores and a reduction in PCT, CRP and IL-6 levels. Trial registration: ClinicalTrials.gov Identifier: NCT02312024 (retrospectively registered).
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Affiliation(s)
- Fatime Hawchar
- Department of Anesthesiology and Intensive Care, University of Szeged, Szeged, Hungary
- * E-mail:
| | - Dana Tomescu
- Department of Anaesthesia and Critical Care, Fundeni Clinical Institute, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Karl Träger
- Kardioanasthesiologie, Universitätsklinikum Ulm, Ulm, Germany
| | - Dominik Joskowiak
- Universitätsklinikum der LMU München, Herzchirurgische Klinik und Poliklinik, Munich, Germany
| | - Klaus Kogelmann
- Klinik für Anästhesiologie und Intensivmedizin, Hans-Susemihl-Krankenhaus GmbH, Emden, Germany
| | - Jens Soukup
- Klinik für Anästhesiologie, Intensivtherapie und Palliativmedizin, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - Singrun Friesecke
- Klinik und Poliklinik für Innere Medizin B, Universitätsmedizin Greifswald, Greifswald, Germany
| | - David Jacob
- Universitätsklinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Jan Gummert
- Herz- und Diabeteszentrum NRW, Klinische Studien Chirurgie, Bad Oeynhausen, Germany
| | | | - Filippo Aucella
- Research Hospital "Casa Sollievo della Sofferenza" Medical Science, Nephrology and Dialysis Unit, San Giovanni, Rotondo, Italy
| | | | - Manu L. N. G. Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
- Medical Data Management, Medaman, Geel, Belgium
- International Fluid Academy, Lovenjoel, Belgium
| | - Ralph Bogdanski
- Klinik für Anästhesiologie, AG Hämodynamik, Klinikumrechts der Isar TU München, München, Germany
| | - Günter Weiss
- Krankenhaus Hietzing, Wiener Krankenanstaltenverbund, A, Wien, Austria
| | - Andreas Herbrich
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum Region Hannover Nordstadt, Hannover, Germany
| | - Stefan Utzolino
- Universitätsklinikum Freiburg, Abteilung Allgemein- und Viszeralchirurgie, Freiburg, Germany
| | - Axel Nierhaus
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg- Eppendorf, Hamburg, Germany
| | - Andreas Baumann
- Klinik für Anästhesie, Intensiv-, Palliativ- und Schmerzmedizin, Berufsgenossensch Uniklinik Bergmannsheil, Bochum, Germany
| | | | - Dietrich Henzler
- Klinikum Herford, UK Anästhesie, Intensivmedizin, Rettungsmedizin, Schmerztherapie, Herford, Germany
| | - Evgeny Grigoryev
- Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
| | - Harald Fritz
- Krankenhaus Martha Maria Halle Klinik für Anaesthesiologie und Intensivmedizin, Halle, Germany
| | - Friedhelm Bach
- Klinik für Anästhesiologie, Intensiv-, Notfallmedizin, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus Bielefeld, Bielefeld, Germany
| | - Stefan Schröder
- Krankenhaus Düren gem. GmbH, Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Düren, Germany
| | - Andreas Weyland
- Universitätsklinik für Anästhesiologie/Intensiv-/Notfallmedizin/Schmerztherapie, Klinikum Oldenburg GmbH, Carl von Ossietzky Universität, Oldenburg, Germany
| | | | - Matthias Menzel
- Klinikum Wolfsburg, Klinik für Anästhesie und Intensivmedizin, Wolfsburg, Germany
| | - Olivier Zachariae
- Klinikum Wolfsburg, Klinik für Anästhesie und Intensivmedizin, Wolfsburg, Germany
| | - Radovan Novak
- Klinikum Oberlausitzer Bergland GmbH, Zittau, Germany
| | - Jernej Berden
- University Medical Centre Ljubljana, Dep. Of Internal medicine, ICU, Ljubljana, Slovenia
| | - Hendrik Haake
- Klinik für Kardiologie und Intensivmedizin, Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
| | - Michael Quintel
- Zentrum Anästhesiologie, Rettungs-und Intensivmedizin, Universitätsklinikum Göttingen, Göttingen, Germany
| | - Stephan Kloesel
- GPR Klinikum Rüsselsheim, Abteilung Anästhesie, Rüsselsheim, Germany
| | - Andreas Kortgen
- Universitätsklinikum Jena, Klinik für Anästhesiologie und Intensivmedizin, Jena, Germany
| | - Stephanie Stecher
- Medizinische Klinik und Poliklinik II, Klinikum der Universität München, München, Germany
| | - Patricia Torti
- Rianimazione Ospedale U. Parini, S.C. Anestesia e Rianimazione, Aosta, Italy
| | | | - Markus Nitsch
- Klinik für Anästhesie, Intensiv-, Notfallmedizin und Schmerztherapie, Krankenhaus St. Elisabeth und St. Barbara, Halle, Germany
| | - Detlef Olboeter
- Krankenhaus Herzberg, Elbe-Elster-Klinikum GmbH, Herzberg, Germany
| | - Philip Muck
- Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Michael Findeisen
- Klinik für Pneumologie, Gastroenterologie, Internistische Intensiv- und Beatmungsmedizin, Städtisches Klinikum München GmbH, Klinikum Harlaching, Munich, Germany
| | - Diane Bitzinger
- Universitätsklinikum Regensburg, Klinik für Anästhesiologie, Regensburg, Germany
| | - Jens Kraßler
- Fachkrankenhaus Coswig, Klinik für Anästhesiologie und Intensivmedizin, Coswig, Germany
| | - Martin Benad
- Bodden Kliniken Ribnitz Damgarten, Ribnitz Damgarten, Germany
| | | | - Ulrike Schumacher
- Center for Clinical Studies Jena (ZKS), Jena University Hospital, Jena, Germany
| | - Zsolt Molnar
- Doctoral School of Multidisciplinary Medical Sciences, University of Szeged, Szeged, Hungary
- Institute for Translational Medicine, School of Medicine, University of Pécs, Pécs, Hungary
- Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Frank Martin Brunkhorst
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
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Mitrovic D, Huntjens DW, de Vos EAJ, van Tellingen M, Franssen EJF. Extracorporeal hemoadsorption with the CytoSorb device as a potential therapeutic option in severe intoxications: Review of the rationale and current clinical experiences. J Clin Pharm Ther 2022; 47:1444-1451. [PMID: 35924306 DOI: 10.1111/jcpt.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Many severe intoxications occur with substances with no specific antidote, which is why methods of extracorporeal elimination represent a particularly useful and even critical component in their management. The purpose of this review is to summarize the accumulating evidence and clinical results from the application of CytoSorb hemoadsorption therapy in patients with severe intoxications. COMMENT The technology represents a promising technique with an increasing number of publications in a variety of severe intoxication scenarios suggesting that early intervention might provide rapid substance removal with subsequent overall clinical improvement. WHAT IS NEW AND CONCLUSION Given the tremendous challenges in performing prospective, randomized trials in this field, the strong safety profile of the device and the high acuity of these life-threatening situations, CytoSorb should be considered as a therapeutic option in severe intoxications, particularly when direct antidotes are not available. However, further clinical data are desirable to provide precise recommendations.
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Affiliation(s)
- Darko Mitrovic
- Hospital Pharmacy, Tjongerschans Hospital Heerenveen, Heerenveen, The Netherlands
| | - Daan W Huntjens
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | | | | | - Eric J F Franssen
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
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Reuchsel C, Gonnert FA. Successful treatment of severe quetiapine intoxication with CytoSorb hemoadsorption. J Clin Pharm Ther 2022; 47:1471-1474. [PMID: 35537706 DOI: 10.1111/jcpt.13668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE While many drug poisonings are successfully treated with specific antidotes, intoxications with tricyclic antidepressants and/or atypical neuroleptics still represent a major challenge. Besides conventional approaches, a new hemoadsorption device might represent an opportunity for therapeutic detoxification. CASE SUMMARY We report a 64-year-old female patient who attempted suicide by ingesting an unknown dose of quetiapine. Following application of all available standard diagnostic and therapeutic measures, she was admitted to the intensive care in a deeply somnolent state. Gastroscopy was performed necessitating analgo-sedation, intubation, and mechanical ventilation. Since quetiapine is in principle not dialysable, CytoSorb hemoadsorption was commenced resulting in a clear and rapid decrease in plasma levels of quetiapine and its metabolite norquetiapine over the next few hours. The next day, analgesia was stopped, the patient became alert, and cooperative so that she could be extubated without issues. CytoSorb blood purification therapy was discontinued after 2 days. One day later, the patient was transferred to a psychiatric clinic. WHAT IS NEW AND CONCLUSION We were able to quickly and efficiently reduce quetiapine and norquetiapine to non-toxic serum levels and to stabilize a critical situation using CytoSorb. Therefore, in the absence of a proven beneficial treatment regimen, the use of CytoSorb might represent an alternative for life-threatening complications of quetiapine intoxication. In particular, intoxications caused by lipophilic agents should be further evaluated.
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Affiliation(s)
- Caterina Reuchsel
- Department of Anesthesiology and Intensive Care Medicine, SRH Klinikum Gera, Gera, Germany
| | - Falk A Gonnert
- Department of Anesthesiology and Intensive Care Medicine, SRH Klinikum Gera, Gera, Germany
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De las Cuevas C, Sanz EJ, Rohde C, de Leon J. Association between myocarditis and antipsychotics other than clozapine: a systematic literature review and a pharmacovigilance study using VigiBase. Expert Rev Clin Pharmacol 2022; 15:65-78. [DOI: 10.1080/17512433.2022.2032659] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Carlos De las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, School of Medicine, University of La Laguna, Canary Islands, Spain
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Emilio J. Sanz
- Department of Physical Medicine and Pharmacology, School of Medicine, Universidad de La Laguna, Canary Islands, Spain
- Hospital Universitario de Canarias, Tenerife, Spain
| | - Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, US
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
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7
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Köhler T, Schwier E, Praxenthaler J, Kirchner C, Henzler D, Eickmeyer C. Therapeutic Modulation of the Host Defense by Hemoadsorption with CytoSorb ®-Basics, Indications and Perspectives-A Scoping Review. Int J Mol Sci 2021; 22:12786. [PMID: 34884590 PMCID: PMC8657779 DOI: 10.3390/ijms222312786] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 01/08/2023] Open
Abstract
The "normal" immune response to an insult triggers a highly regulated response determined by the interaction of various immunocompetent cells with pro- and anti-inflammatory cytokines. Under pathologic conditions, the massive elevation of cytokine levels ("cytokine storm") could not be controlled until the recent development of hemoadsorption devices that are able to extract a variety of different DAMPs, PAMPs, and metabolic products from the blood. CytoSorb® has been approved for adjunctive sepsis therapy since 2011. This review aims to summarize theoretical knowledge, in vitro results, and clinical findings to provide the clinician with pragmatic guidance for daily practice. English-language and peer-reviewed literature identified by a selective literature search in PubMed and published between January 2016 and May 2021 was included. Hemoadsorption can be used successfully as adjunct to a complex therapeutic regimen for various conditions. To the contrary, this nonspecific intervention may potentially worsen patient outcomes in complex immunological processes. CytoSorb® therapy appears to be safe and useful in various diseases (e.g., rhabdomyolysis, liver failure, or intoxications) as well as in septic shock or cytokine release syndrome, although a conclusive assessment of treatment benefit is not possible and no survival benefit has yet been demonstrated in randomized controlled trials.
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Affiliation(s)
- Thomas Köhler
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr University Bochum, Klinikum Herford, 32120 Herford, Germany; (E.S.); (J.P.); (D.H.); (C.E.)
| | - Elke Schwier
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr University Bochum, Klinikum Herford, 32120 Herford, Germany; (E.S.); (J.P.); (D.H.); (C.E.)
| | - Janina Praxenthaler
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr University Bochum, Klinikum Herford, 32120 Herford, Germany; (E.S.); (J.P.); (D.H.); (C.E.)
| | - Carmen Kirchner
- Department of General and Visceral Surgery, Thoracic Surgery and Proctology, Ruhr University Bochum, Klinikum Herford, 32120 Herford, Germany;
| | - Dietrich Henzler
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr University Bochum, Klinikum Herford, 32120 Herford, Germany; (E.S.); (J.P.); (D.H.); (C.E.)
| | - Claas Eickmeyer
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr University Bochum, Klinikum Herford, 32120 Herford, Germany; (E.S.); (J.P.); (D.H.); (C.E.)
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8
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Reuchsel C, Gonnert FA. Successful Treatment of Severe Lamotrigine Intoxication with CytoSorb Hemoadsorption. Blood Purif 2021; 51:679-682. [PMID: 34736249 DOI: 10.1159/000519167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/22/2021] [Indexed: 11/19/2022]
Abstract
Severe intoxication with the anti-epileptic drug, lamotrigine can cause cardiovascular collapse, neurotoxicity - expressed as intractable seizures, and even death. As there is currently no known specific antidote, extracorporeal removal therapies such as CytoSorb hemoadsorption might represent a promising therapeutic option. We report on a deeply comatosed 60-year-old woman who was treated in our intensive care unit with severe lamotrigine intoxication. To support removal from the blood, combined treatment with continuous veno-venous hemodialysis and CytoSorb hemoadsorption was started. Pre- and post-adsorber drug level measurements showed the rapid elimination of lamotrigine accompanied by an impressive clinical improvement in the patient. Two days after treatment discontinuation, there were no more clinical signs of intoxication and the patient could be extubated, followed by transfer to the stroke unit in a stable condition the following day. In the absence of a viable antidote, for the efficient short-term removal of lamotrigine, hemoadsorption with the CytoSorb device could represent a feasible treatment option for patients with severe lamotrigine intoxication.
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Affiliation(s)
- Caterina Reuchsel
- Department of Anesthesiology and Intensive Care Medicine, SRH Klinikum Gera, Gera, Germany
| | - Falk Alexander Gonnert
- Department of Anesthesiology and Intensive Care Medicine, SRH Klinikum Gera, Gera, Germany
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Zickler D, Nee J, Arnold T, Schröder T, Slowinski T, Eckardt KU, Körner R, Kruse JM. Use of Hemoadsorption in Patients With Severe Intoxication Requiring Extracorporeal Cardiopulmonary Support-A Case Series. ASAIO J 2021; 67:e186-e190. [PMID: 33587468 DOI: 10.1097/mat.0000000000001362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Drugs intoxications often lead to severe vasoplegia and cardiogenic shock, and VA-ECMO represents a viable therapy option. However, as cardiopulmonary support is not contributing to the removal of the causal agent from the blood, detoxification by a new hemoadsorption device (CytoSorb) could represent a potential therapeutic tool due to its highly efficient elimination capacity of endogenous but also exogenous hydrophobic substances for which otherwise no effective antidote exist. In this case series, four anecdotal cases of acute intoxications requiring VA-ECMO support used as extracorporeal cardiopulmonary resuscitation after intoxication-induced out-of-hospital cardiac arrest (OHCA) are presented, who were additionally treated with CytoSorb hemoadsorption in combination with renal replacement therapy. Combined treatment was associated with a considerable decrease in plasma levels of the overdosed drugs. Additionally, the combination of applied techniques was safe, practical, and technically feasible with no adverse or any device-related side effects documented during or after the treatment sessions. Based on the reported dramatic decline in drug levels during treatment, that fits in the device's characteristics, we strongly suggest to further investigate the potentially lifesaving role of CytoSorb therapy in patients with acute intoxications requiring multiple organ support techniques.
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Affiliation(s)
- Daniel Zickler
- From the Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Berlin Institute of Health, Clinic for Nephrology and Intensive Care Medicine, Humboldt-Universität zu Berlin, Berlin, Germany
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10
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Getsina M, P'yanova L, Kornienko N, Lavrenov A, Ershov A, Beloborodova N. Applicability of modified carbon sorbent for removing potentially toxic biologically active molecules of aromatic structure from blood plasma. Int J Artif Organs 2021; 44:930-937. [PMID: 34137293 DOI: 10.1177/03913988211018478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The modification of the mesoporous carbon sorbent with 3-phenylpropanoic acid was carried out in order to create preparations of complex, prolonged action, exhibiting detoxifying, antibacterial, and antifungal properties due to the applied modifier, which is capable of migrating into the solution and exhibiting its own biospecific properties. A technique was developed for fixing 3-phenylpropionic acid (PhPA) on a carbon support by its adsorption from solution. Three types of sorbents with various content of the modifier (PhPA) and the sorbent without modifier were studied. The sorption activity of new sorbents was studied using liquid-liquid extraction and gas chromatography-mass spectrometry methods on model experiments with plasma and aqueous additives of hydroxylated phenyl-containing acids (PhCAs) in various concentrations. The specific surface area was significantly changed for sorbent, modified with 1 × 10-3 mol/L of PhPA solution, and was 25% less than the area of unmodified sorbent. Potentially toxic biologically active hydroxylated PhCAs were used to create model solutions. The degrees of sorption of these compounds were close to 100%, except phenyllactic acid (over 80%). The sorbent without modifier and two sorbents with the lowest content of the modifier are considered to be more effective for the purification of the plasma from the hydroxylated PhCAs than the sorbent with the highest concentration of the modifier. Simultaneous adsorption of toxic metabolites from the bloodstream and desorption of beneficial ones can be used for a more subtle correction of the patient's condition.
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Affiliation(s)
- Maria Getsina
- Laboratory of Human Metabolism in Critical States, Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation
| | - Lidia P'yanova
- Center of New Chemical Technologies of the Federal Research Center Boreskov Institute of Catalysis of Siberian Branch of the Russian Academy of Sciences, Omsk, Russian Federation
| | - Natalia Kornienko
- Center of New Chemical Technologies of the Federal Research Center Boreskov Institute of Catalysis of Siberian Branch of the Russian Academy of Sciences, Omsk, Russian Federation
| | - Alexander Lavrenov
- Center of New Chemical Technologies of the Federal Research Center Boreskov Institute of Catalysis of Siberian Branch of the Russian Academy of Sciences, Omsk, Russian Federation
| | - Anton Ershov
- Laboratory of Human Metabolism in Critical States, Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation
| | - Natalia Beloborodova
- Laboratory of Human Metabolism in Critical States, Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation
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11
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Breuer TGK, Quast DR, Wiciok S, Labedi A, Ellrichmann G. Successful Treatment of Severe Digitoxin Intoxication with CytoSorb® Hemoadsorption. Blood Purif 2020; 50:137-140. [PMID: 32937619 DOI: 10.1159/000510292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022]
Abstract
While several intoxications can be successfully treated with specific antidotes, intoxications with the steroid glycoside digitoxin still represent a major challenge. Besides conventional approaches, CytoSorb® hemoadsorption might be another treatment option. We report on an 81-year-old female patient treated in our intensive care unit (ICU) with severe digitoxin intoxication, acute renal failure, and urinary tract infection (UTI). As physiological digitoxin elimination kinetics are known to appear slow, and also in regard to the renal failure, the decision was made to initiate continuous renal replacement therapy combined with CytoSorb hemoadsorption. The patient was hemodynamically stabilized within the first 4 h of treatment and initially required catecholamines to be stopped within 24 h of treatment. Pre- and post-adsorber drug level measurements showed a rapid elimination of digitoxin. Antibiotic treatment with piperacillin/tazobactam was initiated, and despite CytoSorb hemoadsorption therapy and its known potential to reduce plasma concentrations of several drugs, the UTI was successfully treated. After 3 days of CytoSorb treatment, digitoxin plasma levels were stable and almost normalized, and no clinical signs of intoxication were present. Five days after presentation, the patient was transferred from the ICU in a stable condition. CytoSorb hemoadsorption may be an easily available, efficient, and less cost-intensive therapy option than treatment with the Fab fragment, which is the currently recommended therapy for digitalis intoxications. Therefore, the use of CytoSorb might represent an alternative treatment for life-threatening complications of digitoxin intoxications.
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Affiliation(s)
- Thomas Georg Karl Breuer
- Department of Internal Medicine/Intensive Care, St. Josef Hospital Bochum, Ruhr-University, Bochum, Germany,
| | - Daniel Robert Quast
- Department of Internal Medicine/Intensive Care, St. Josef Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Stephan Wiciok
- Department of Cardiology, St. Josef Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Adnan Labedi
- Department of Neurology, St. Josef Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Gisa Ellrichmann
- Department of Neurology, St. Josef Hospital Bochum, Ruhr-University, Bochum, Germany
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