Use of Hemoadsorption in Patients With Severe Intoxication Requiring Extracorporeal Cardiopulmonary Support—A Case Series

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.

The Potential Role of Extracorporeal Cytokine Removal in Hemodynamic Stabilization in Hyperinflammatory Shock

“…Out of the 163 clinical articles available in PubMed, 58 were identified that mentioned "catecholamines and/or vasopressors". In total, 25 papers were excluded; 12 because of non-comparability of the measurement scales [25][26][27][28][29][30][31][32][33][34][35][36]; 4 because the type and dose of vasopressors were not specified [37][38][39][40]; 1 that reported combined norepinephrine and epinephrine doses [41]; 1 that only reported on patients that had survived [42]; and 7 where there were no measurements pre-and post-adsorber use in the same patient [43][44][45][46][47][48][49]. The remaining 33 articles were summarized without considering different study designs or duration of treatment.…”

Successful treatment of severe quetiapine intoxication with CytoSorb hemoadsorption

“…Still, we find our decision to use the adsorber justified based on the critical situation and the lack of other alternatives. Generally, more and more reports on the use of CytoSorb in intoxications are meanwhile available and the reported cases do not only include those, in which complications like, for example, shock states were addressed with the therapy, 10 but also those, in which, similar as in our setting, direct detoxification was targeted 11 …”

Extracorporeal hemoadsorption with the CytoSorb device as a potential therapeutic option in severe intoxications: Review of the rationale and current clinical experiences

“…7 So far 13 publications, including 17 patients have reported on the use of CytoSorb therapy in various intoxication settings (see Table 1), with the largest experience to date originating from the Charite Hospital in Berlin, Germany. 8 In this case series Zickler et al describe 4 anecdotal cases of acute intoxication (anti-hypertensives amlodipine and bisoprolol as well as the antidepressant amitriptyline) requiring Veno-Arterial (VA) ECMO) support used for extracorporeal cardiopulmonary resuscitation after intoxicationinduced out-of-hospital cardiac arrest (OHCA). 8 All patients were additionally treated with renal replacement therapy with CytoSorb treatment ranging from 1 to 7 days.…”

“…8 In this case series Zickler et al describe 4 anecdotal cases of acute intoxication (anti-hypertensives amlodipine and bisoprolol as well as the antidepressant amitriptyline) requiring Veno-Arterial (VA) ECMO) support used for extracorporeal cardiopulmonary resuscitation after intoxicationinduced out-of-hospital cardiac arrest (OHCA). 8 All patients were additionally treated with renal replacement therapy with CytoSorb treatment ranging from 1 to 7 days. In these patients combined treatment was consistently associated with a dramatic decline in drug levels during treatment of all the overdosed drugs.…”