Innovations in medicine: The stabilizer

spiegel.de, 5.01.2015

from Christian Heinrich

Blood poisoning is the third leading cause of death in Germany. Using a new cylindrical apparatus doctors could potentially save more people. Episode one of our series on medical innovations.

It is a small cylinder, half as long as a forearm that could have saved the patient’s life. In the summer in Munich, the nearly 50-year-old man was brought in the emergency room of the hospital Großhadern, he has a severe peritonitis. A part of the small intestine is torn and the intestinal fluids have leaked into the abdomen.

The inflammation is transferred to the whole cycle; it is called sepsis in professional terminology. This spread of the pathogen is extremely dangerous because it can go everywhere in the body, and because the own immune system overreacts: Gradually the own organs are crippling. Every day statistically 162 people die from sepsis, because the disease eludes many treatment approaches.

To prevent this, the blood of the patient from Munich is diverted through a cylindrical construction called Cytosorb – similar to dialysis. The device of the US company Cytosorbents binds some of the substances that are responsible for the excessive immune response in the body, especially the so-called cytokines. Cytosorb filters these messenger substances out of the blood, which could help bridge important time.
What has saved the man´s life?
The man in Munich remains stable until surgery, and then he recovers quickly. “However, whether Cytosorb has saved the patient´s life or whether he might have survived anyway, we do not know,” says the anesthetic senior physician Michael Zoller, who also supervised the man. “Especially in intensive care so many factors are involved that one can hardly speak of one life-saving component.” Zoller who has already used Cytosorb several dozen times, is convinced that the system allows physicians to some extent to regain control of the condition of severely ill patients.
In Germany almost 60,000 people die annually from sepsis, after the heart attack it is the third leading cause of death. But the phenomenon is discussed surprisingly little in public. This is partly because sepsis is a result of severe trauma or inflammation – these original diseases are usually in the center of attention. But when the body then suddenly overreacts, patients are quickly in mortal danger. Take the reins of the immune defense. “The big problem is that we cannot do much against the body’s own excessive inflammatory response,” says doctor Karl Träger, who runs a cardiac surgical intensive care unit at the University Hospital of Ulm. He also has already applied the Cytosorb technology. His experience so far: “Circulatory and cardiac function of patients stabilize quickly, the cytokine levels in the blood significantly fall within twelve to 24 hours,” says Träger. “With the help of the device, we can take the runaway immunological defense back on the reins.” That sounds promising, but no one can say for sure what else Cytosorb removes from the blood. Does the device also bind other substances that are vital? Then although there is no evidence so far, it seems that a few types of antibiotics remain in the adsorber. This could block life-saving therapies. Thus it is important to reocrd the antibiotics. “In the meantime a registry has been set up in order to better study the effect of Cytosorb”, says Träger. In Germany, the device is used in 50 clinics, since 2011 it has been approved in Europe. Only in a few patients, the therapy has shown no effect.

Case studies give rise to hope
If successful, the device could be given for complex operations such as in difficult heart surgeries for protection against complications or sepsis, it could be effective in selected ICU patients or after accidents. The US army currently investigates the use of the device for complex trauma with multiple organ failure.
However the development is not yet so far. Only when a positive effect can be shown in a large study on the probability of survival of patients, the unit would have a chance to be used by default. The number of previously published case studies makes at least hope. If no additional adverse effects occur, the device could significantly reduce the death rate caused by sepsis.