Case Report: Successful Use of Extracorporeal Therapies After ECMO Resuscitation in a Pediatric Kidney Transplant Recipient

Rybalko, A.G.; Pytal, Anna; Каабак, М М; Rappoport, Nadejda; Bidzhiev, A. R.; Lastovka, Vasilii

doi:10.3389/fped.2020.593123

Cited by 5 publications

(4 citation statements)

References 25 publications

(24 reference statements)

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“…Moreover, the influence of the timing of CRRT initiation and termination is covered. In a case study, Rybalko successfully treated a patient with a complex medical condition with a combination of ECMO and multiple extracorporeal blood purification methods, including PE, CA, and lipopolysaccharide adsorption [62]. This report demonstrates the potential benefits of a multimodal approach to extracorporeal therapies in the setting of immunosuppression therapy.…”

Section: Clinical Studiesmentioning

confidence: 84%

Hemoadsorption in Organ Preservation and Transplantation: A Narrative Review

García-Villegas,

Arni

2023

Life

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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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Section: Clinical Studiesmentioning

confidence: 84%

Hemoadsorption in Organ Preservation and Transplantation: A Narrative Review

García-Villegas,

Arni

2023

Life

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“…After excluding irrelevant articles (i.e., reviews, meta-analyses, protocols, letters), 60 studies were retrieved ( Figure 2 ). Of these, 22 were excluded due to their focus on veno-arterial ECMO (V-A ECMO) or extracorporeal cardiopulmonary resuscitation (ECPR) [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Fourteen studies were excluded for lack or scarcity of data on CytoSorb© use [ 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ], four because of the lack of specific data for the ECMO subgroup [ 67 , 68 , 69 , 70 ], four because CytoSorb© was not used concomitantly with ECMO therapy [ 71 , 72 , 73 , 74 ], two because outcomes of interest for the simultaneous use of CytoSorb© and ECMO were not reported [ 75 , 76 ], and one because it focused on a different device [ 77 ].…”

Section: Resultsmentioning

confidence: 99%

Use of CytoSorb© Hemoadsorption in Patients on Veno-Venous ECMO Support for Severe Acute Respiratory Distress Syndrome: A Systematic Review

Akil¹,

Napp

Rao

et al. 2022

JCM

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Acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality. Adjunct hemoadsorption is increasingly utilized to target underlying hyperinflammation derived from ARDS. This article aims to review available data on the use of CytoSorb© therapy in combination with V-V ECMO in severe ARDS, and to assess the effects on inflammatory, laboratory and clinical parameters, as well as on patient outcomes. A systematic literature review was conducted and reported in compliance with principles derived from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. When applicable, a before-and-after analysis for relevant biomarkers and clinical parameters was carried out. CytoSorb© use was associated with significant reductions in circulating levels of C-reactive protein and interleukin-6 (p = 0.039 and p = 0.049, respectively). Increases in PaO2/FiO2 reached significance as well (p = 0.028), while norepinephrine dosage reductions showed a non-significant trend (p = 0.067). Mortality rates in CytoSorb© patients tended to be lower than those of control groups of most included studies, which, however, were characterized by high heterogeneity and low power. In an exploratory analysis on 90-day mortality in COVID-19 patients supported with V-V ECMO, the therapy was associated with a significantly reduced risk of death. Based on the reviewed data, CytoSorb© therapy is able to reduce inflammation and potentially improves survival in ARDS patients treated with V-V ECMO. Early initiation of CytoSorb© in conjunction with ECMO might offer a new approach to enhance lung rest and promote recovery in patients with severe ARDS.

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“…Несмотря на то что производителем картриджа для PMX-гемоперфузии рекомендована схема лечения 2 сеанса по 2 ч, многие исследователи применяли и более длительные и многократные варианты Особый интерес заслуживает описание клинического случая отечественными педиатрами [16] успешное лечения септического шока, вызванного транслокацией панрезистентной клебсиеллы, после родственной трансплантации почки. В работе показано комбинированное применение системы жизнеобеспечения ЭКМО и 3 сеансов по 8 ч PMX-гемоперфузии.…”

Section: Conflict Of Interestunclassified

Treatment of endotoxemia and prevention of shock with the help of multiple adsorption of lipopolysaccharide: description of a clinical case and literature review

Бабаев¹,

Eremenko²,

Zyulyaeva³

et al. 2022

Clinical and Experimental Surgery. Petrovsky journal

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Endotoxemia is a common cause of shock and poor outcomes in sepsis. This paper describes a case of recovery of a young patient from sepsis caused by pan-resistant bacterial flora after a car injury with aortic rupture. Multiple adsorption of lipopolysaccharide was used as part of complex therapy to treat endotoxemia. Material and methods. A17-year old patient K., diagnosed with a condition after polytrauma, accompanied by aortic rupture, complicated by multiple organ dysfunction and sepsis (SOFA score up to 14 points): coma I-II; paresis of the gastrointestinal tract; respiratory failure due to pneumonia; acute kidney injury with anuria; acute liver failure; thrombocytopenia. The sources of infection were: translocation of bacteria; sinusitis, meningoencephalitis. In bacterial blood cultures, the presence of both gram-positive and gram-negative multi-resistant flora was identified. The level of procalcitonin, depending on the activity of the infectious process, ranged from 35 to 336 ng/ml. Surgical interventions to drain and sanitize the focus of infection as well as repeated changes in antibiotic therapy were performed in order to control the infectious process. The level of endotoxemia was assessed by endotoxin activity assay (EAA from 0.7 to 1). 60 hours of polymyxin B (PMX) hemoperfusion (5 sessions) were performed in conjunction with continuous use of the Oxiris universal set. Results. In 100 days after hospitalization, the patient had no signs of infection, was conscious, breathing spontaneously, had partially restored motor and speech functions and was transferred to a rehabilitation center. After each PMX hemoperfusion [a 12-hour (h) session followed by a 12-h break before the next 12-h session], EAA value reduced or didn't increase above 0.7. After the first 12 hours of use, it was possible to withdraw vasopressors, oxygenation index significantly increased, signs of shock were no longer observed; after 2 sessions peristalsis was restored. According to the literature, repeated PMX hemoperfusion sessions have been used in the treatment of patients with septic shock associated with endotoxemia caused by translocation of the intestinal flora, and in patients with an infectious focus in the lungs or other organs, after transplantation of parenchymal organs and as a replacement for antibiotic therapy. The indications for the procedure were: an increase of EAA over 0.6; high SOFA values; the presence of gram-negative microorganisms. Conclusion.The heterogeneity of the course of sepsis requires a multidisciplinary, complex and targeted treatment. Patients with severe multiple organ dysfunction and severe endotoxemia represent the most unfavorable cohort of patients with sepsis and can be identified using a blood женной эндотоксемией представляют наиболее неблагоприятную когорту больных с сепсисом и могут быть идентифицированы с помощью теста на активность липополисахарида в крови. Тест на активность эндотоксина в крови также позволяет судить о природе бактериальной флоры, отслеживать наличие очага инфекции, аде...

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Case Report: Successful Use of Extracorporeal Therapies After ECMO Resuscitation in a Pediatric Kidney Transplant Recipient

Cited by 5 publications

References 25 publications

Hemoadsorption in Organ Preservation and Transplantation: A Narrative Review

Hemoadsorption in Organ Preservation and Transplantation: A Narrative Review

Use of CytoSorb© Hemoadsorption in Patients on Veno-Venous ECMO Support for Severe Acute Respiratory Distress Syndrome: A Systematic Review

Treatment of endotoxemia and prevention of shock with the help of multiple adsorption of lipopolysaccharide: description of a clinical case and literature review

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