Use of CytoSorb in a case of severe post reanimation shock

Dr. med. Hendrik Haake, Dr. med. Katharina Grün-Himmelmann & Prof. Jürgen vom Dahl
St. Franziskus-Hospital Mönchengladbach, Germany,Department of Cardiology and Intensive Care Medicine

Summary:

Case presentation

  • Patient was admitted to ICU with mechanical ventilation and moderate demand for catecholamines (noradrenaline 0.5 mg/h)
  • Instantaneous cardiac catheter examination with exclusion of coronary heart disease
  • Immediate hypothermia treatment for 24 hours at 34°C
  • Thereafter warming up at 0.25°C/hour until target temperature of 36°C
  • PiCCO-guided catecholamine and volume therapy due to ensuing hemodynamic instability and progressively increasing needs for catecholamines
  • Development of oliguric acute kidney failure and a shock pancreas with considerably elevated lipase plasma levels (6000 U/l)
  • Due to the acute kidney failure and the progressive need for catecholamines (NOR 10 mg/h, dobutamine 50 mg/h) a CytoSorb adsorber was installed in combination with CVVHD

Treatment

  • One CytoSorb treatment for 48 hours
  • CytoSorb was used in conjunction with CRRT (Multifiltrate, Fresenius Medical Care) in CVVHD mode
  • Blood flow rate: 150 ml/min
  • Anticoagulation: heparin
  • CytoSorb adsorber position: pre-hemofilter

Measurements

  • Hemodynamic variables measured using PiCCO (CI, SVRI, ITBVI)
  • Demand for catecholamines
  • Renal function (creatinine, urea, diuresis)
  • Inflammatory parameters (CRP, PCT, WBC)

Results

  • Hemodynamic stabilization (CI, SVRI, ITBVI) of the patient along with significantly decreased needs for catecholamines within 14 hours (noradrenaline 2 mg/h, dobutamine 30 mg/h )
  • Significantly declining renal retention parameters under CVVHD
  • Reduction of inflammatory parameters (CRP, WBC)

Patient Follow-Up

  • In the further course development of a bilateral pneumonia necessitating installation of veno-venous ECMO for another 9 days
  • Termination of renal replacement therapy 6 days after initial CytoSorb treatment
  • Subsequent transfer to IMC and several days later to general ward
  • Finally, implantation of an automatic cardioverter-defibrillator and successful transfer of patient to a rehabilitation unit

Conclusions

  • Successful application of CytoSorb in a case of post-reanimation shock
  • Treatment with CytoSorb resulted in significant stabilization of hemodynamics with declining needs for catecholamines within a few hours
  • Application of CytoSorb was safe and easy