Options in extracorporeal support of multiple organ failure

Huber, Wolfgang; Garibay, Aritz Pérez Ruiz de

doi:10.1007/s00063-020-00658-3

Cited by 16 publications

(26 citation statements)

References 59 publications

(41 reference statements)

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“…Huber recently reported ADVOS to be “the first integrated MOST device” (MOST = multiple organ support therapy). [ 32 ] In this review, they were highlighted the specific features of the “intelligent” dialysate of ADVOS, which can be adapted to the patient needs, allowing a correction of acid-base imbalances, including CO 2 removal. [ 20 , 21 ] A recent publication from his group reported a median CO 2 removal of 48 ml/minutes in a COVID-19 patient with multiple organ failure.…”

Section: Discussionmentioning

confidence: 99%

Registry on extracorporeal multiple organ support with the advanced organ support (ADVOS) system

Fuhrmann

Garibay²,

Faltlhauser

et al. 2021

Medicine

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The objective of this registry is to collect data on real-life treatment conditions for patients for whom multiple organ dialysis with Advanced Organ Support (ADVOS) albumin hemodialysis is indicated. This registry was performed under routine conditions and without any study-specific intervention, diagnostic procedures, or assessments. Data on clinical laboratory tests, health status, liver function, vital signs, and examinations were collected (DRKS-ID: DRKS00017068). Mortality rates 28 and 90 days after the first ADVOS treatment, adverse events and ADVOS treatment parameters, including treatment abortions, were documented. This analysis was performed 2 years after the first patient was included on January 18, 2017. As of February 20, 2019, 4 clinical sites in Germany participated and enrolled 118 patients with a median age of 60 (IQR: 45, 69) of whom 70 were male (59.3%). Patients had a median SOFA Score of 14 (IQR: 11, 16) and a predicted mortality of 80%. The median number of failing organs was 3 (IQR: 2, 4). Four hundred twenty nine ADVOS treatments sessions were performed with a median duration of 17 hours (IQR: 6, 23). A 5.8% of the ADVOS sessions (25 of 429) were aborted due to device related errors, while 14.5% (62 of 429) were stopped for other reasons. Seventy nine adverse events were documented, 13 of them device related (all clotting, and all recovered without sequels). A significant reduction in serum creatinine (1.5 vs 1.2 mg/dl), blood urea nitrogen (24 vs 17 mg/dl) and bilirubin (6.9 vs 6.5 mg/dl) was observed following the first ADVOS treatment session. Blood pH, bicarbonate (HCO3 -) and base excess returned to the physiological range, while partial pressure of carbon dioxide (pCO2) remained unchanged. At the time of the analysis, 28- and 90-day mortality were 60% and 65%, respectively, compared to an expected ICU-mortality rate of 80%. SOFA score was an independent predictor for outcome in a multivariable logistic regression analysis. The reported data show a high quality and completion of all participating centers. Data interpretation must be cautious due to the small number of patients, and the nature of the registry, without a control group. However, the data presented here show an improvement of expected mortality rates. Minor clotting events similar to other dialysis therapies occurred during the treatments.

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Section: Discussionmentioning

confidence: 99%

Registry on extracorporeal multiple organ support with the advanced organ support (ADVOS) system

Fuhrmann

Garibay²,

Faltlhauser

et al. 2021

Medicine

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“…During the late 1990s and the 2000s, marketing of extracorporeal liver support systems to eliminate protein‐bound toxins began. These include albumin dialysis therapies such as single‐pass albumin dialysis (SPAD) and the Molecular Adsorbent Recirculating System (MARS®), the fractionized plasma separation and adsorption system (Prometheus®), high‐volume plasma exchange (HVP), extracorporeal bioartificial cellular therapies using extracorporeal liver cell bioreactors for blood purification and more recently, hemadsorption 7 . Initial clinical studies demonstrated multiple benefits, although the results of subsequent randomized clinical trials reduced the initial euphoria 8 .…”

Section: Introductionmentioning

confidence: 99%

“…These single‐organ support devices may be implemented as and when required to support failing organ systems and are familiar to the intensive care staff accustomed to their daily use. However, the use of multiple single‐organ support devices can mandate a large extra‐corporeal volume, is cumbersome, requires additional time for their set‐up and maintenance, and is associated with significant financial implications 7 . This being said, many authors point toward a multiple organ support therapy (MOST), which would integrate several single‐organ support systems into one device 15–17 to limit extra‐corporeal blood volume and reduce operator effort.…”

Section: Introductionmentioning

confidence: 99%

The role of the ADVanced Organ Support (ADVOS) system in critically ill patients with multiple organ failure

2022

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Background: Multi-organ failure characterized by acute kidney injury, liver dysfunction, and respiratory failure is a complex condition associated with high mortality, for which multiple individual support devices may be simultaneously required. This review aims to appraise the current evidence for the ADVanced Organ Support (ADVOS) system, a novel device integrating liver, lung, and kidney support with blood detoxification. Methods:We performed a literature review of the PubMed database to identify human and animal studies evaluating the ADVOS system. Results:In porcine models of acute liver injury and small clinical studies in humans, ADVOS significantly enhanced the elimination of water-soluble and protein-bound toxins and metabolites, including creatinine, ammonia, blood urea nitrogen, and lactate. Cardiovascular parameters (mean arterial pressure, cerebral perfusion pressure, and cardiac index) and renal function were improved. ADVOS clears carbon dioxide (CO 2 ) effectively with rapid correction of pH abnormalities, achieving normalization of CO 2 , and bicarbonate levels. In patients with COVID-19 infection, ADVOS enables rapid correction of acid-base disturbance and respiratory acidosis. ADVOS therapy reduces mortality in multiorgan failure and has been shown to be safe with minimal adverse events. Conclusions:From the small observational studies analyzed, ADVOS demonstrates excellent detoxification of water-soluble and protein-bound substances. In particular, ADVOS permits the correction of metabolic and respiratory acidosis through the fluid-based direct removal of acid and CO 2 . ADVOS is associated with significant improvements in hemodynamic and biochemical parameters, a trend toward improved survival in multi-organ failure, and is well-tolerated.Larger randomized trials are now necessary to further validate these encouraging results.

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“…Munich, Germany) system, is an albumin hemodialysis approach for elimination of water-soluble and protein-bound toxins, CO 2 removal and acid-base balance control. 7 – 9 A combination of multiple organ support (i.e. kidney, liver, lung) and of low invasiveness (blood flow 10-times lower than ECMO; need for conventional dialysis catheter; absence of gas phase), make ADVOS a promising approach for patients with multiple organ failure, including those with severe COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal multiorgan support including CO₂-removal with the ADVanced Organ Support (ADVOS) system for COVID-19: A case report

et al. 2020

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A substantial part of COVID-19-patients suffers from multi-organ failure (MOF). We report on an 80-year old patient with pulmonary, renal, circulatory, and hepatic failure. We decided against the use of extracorporeal membrane oxygenation (ECMO) due to old age and a SOFA-score of 13. However, the patient was continuously treated with the extracorporeal multi-organ- “ADVanced Organ Support” (ADVOS) device (ADVITOS GmbH, Munich, Germany). During eight 24h-treatment-sessions blood flow (100–300 mL/min), dialysate flow (160–320 mL/min) and dialysate pH (7.6–9.0) were adapted to optimize arterial PaCO2 and pH. Effective CO2 removal and correction of acidosis could be demonstrated by mean arterial- versus post-dialyzer values of pCO2 (68.7 ± 13.8 vs. 26.9 ± 11.6 mmHg; p < 0.001). The CO2-elimination rate was 48 ± 23mL/min. The initial vasopressor requirement could be reduced in parallel to pH-normalization. Interruptions of ADVOS-treatment repeatedly resulted in reversible deteriorations of paCO2 and pH. After 95 h of continuous extracorporeal decarboxylating therapy the patient had markedly improved circulatory parameters compared to baseline. In the context of secondary pulmonary infection and progressive liver failure, the patient had a sudden cardiac arrest. In accordance with the presumed patient will, we decided against mechanical resuscitation. Irrespective of the outcome we conclude that extracorporeal CO2 removal and multiorgan-support were feasible in this COVID-19-patient. Combined and less invasive approaches such as ADVOS might be considered in old-age-COVID-19 patients with MOF.

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Options in extracorporeal support of multiple organ failure

Cited by 16 publications

References 59 publications

Registry on extracorporeal multiple organ support with the advanced organ support (ADVOS) system

Registry on extracorporeal multiple organ support with the advanced organ support (ADVOS) system

The role of the ADVanced Organ Support (ADVOS) system in critically ill patients with multiple organ failure

Extracorporeal multiorgan support including CO₂-removal with the ADVanced Organ Support (ADVOS) system for COVID-19: A case report

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Options in extracorporeal support of multiple organ failure

Cited by 16 publications

References 59 publications

Registry on extracorporeal multiple organ support with the advanced organ support (ADVOS) system

Registry on extracorporeal multiple organ support with the advanced organ support (ADVOS) system

The role of the ADVanced Organ Support (ADVOS) system in critically ill patients with multiple organ failure

Extracorporeal multiorgan support including CO2-removal with the ADVanced Organ Support (ADVOS) system for COVID-19: A case report

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Extracorporeal multiorgan support including CO₂-removal with the ADVanced Organ Support (ADVOS) system for COVID-19: A case report