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Case of the week 15/2021

Pericarditis Caused by Enterococcus faecium with Acute Liver Failure Treated by a Multifaceted Approach including Antimicrobials and Hemoadsorption

Thomas Köhler,1 Mathias W. Pletz,2 Simon Altmann,1 Carmen Kirchner,3 Elke Schwier,1 Dietrich Henzler,1 Günther Winde,3 and Claas Eickmeyer1
1Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr University Bochum, Klinikum Herford, Herford, Germany  
Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
3Department of General and Visceral Surgery, Thoracic Surgery and Proctology, Ruhr University Bochum, Klinikum Herford, Herford, Germany

Case Reports in Critical Care 2021; epub

This case reports on a 29-year-old woman with a history of Crohn’s disease and cachexia, who was hospitalized due to painful diarrhea and unintentional weight loss of 13 kilograms over the previous three weeks caused by a mechanical ileus.

The Therapy

An extracorporeal blood purification method to reduce excess inflammatory mediators and elevated levels of bilirubin and myoglobin.

Fields of application

Septic shock in intensive care, vasoplegic shock in non-infectious triggers (e.g., in cardiac surgery patients), liver failure, rhabdomyolysis.

The Studies

Current multi and single center studies in Europe and USA, an international register, case series.

The Adsorber

The innovative bead technology is the core of CytoSorb, the first and only 24-hour-licensed extracorporeal cytokine adsorber.

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The CytoSorb whole blood adsorber is a CE approved medical device for the extracorporeal removal of cytokines. The aim is to reduce excessive cytokine levels and other inflammatory mediators, while maintaining the physiological immune response. In addition, the removal of elevated levels of bilirubin and myoglobin by the adsorber has been confirmed.

It has also been observed that other hydrophobic substances of medium molecular size, such as free hemoglobin and various bacterial enterotoxins, can also be effectively removed.

CytoSorb consists of innovative porous polymer beads. This unique adsorbing technology offers the highest biocompatibility and hemocompatibility according to ISO 10993. The enormous total surface area of ​​45,000 m² per cartridge enables a highly effective elimination.

The CytoSorb treatment is intended for use in clinical situations with elevated levels of cytokine and / or bilirubin and / or myoglobin. Excessive inflammatory states are attenuated and the immune response modulated.

CytoSorb therapy is used in patients with various types of hyperinflammatory and infectious conditions such as, in particular, septic shock and systemic hyperinflammation during or after cardiopulmonary bypass in cardiac surgery (e.g., endocarditis, aortic aneurysm). Other potential indications include trauma, burns, pancreatitis, necrotizing fasciitis, combination with ECMO, liver failure and rhabdomyolysis.

In particular, haemodynamic stabilization, reduction of capillary leakage, reversal of fluid balance, improvement of organ functions as well as prevention and limitation of organ failure can be observed as therapeutic effects. REGAIN CONTROL!

The CytoSorb adsorber is a standard whole blood cartridge that is compatible with either standard clinical renal replacement therapy (CRRT), such as continuous dialysis and hemofiltration, or with heart-lung machines, or can be used as a stand-alone therapy.

The system can be set up in minutes and easily integrated into existing extracorporeal circuits without additional accessories. Safely performing CytoSorb therapy is possible with both heparin and citrate anticoagulation.

Patients can benefit from CytoSorb use in both intensive therapeutic interventions and preventive use during cardiopulmonary bypass during cardiac surgery.

To date, more than 121,000 individual applications have been performed in more than 800 clinical settings worldwide, with the treatment being well tolerated and safe.

The introduction of a new extracorporeal therapy in critical care requires maximum effort in the medical-scientific arena in order to quickly establish evidence of safety and efficacy, but also extensive knowledge regarding potential additional effects, such as interactions with established therapies. CytoSorbents is continuously working on this.

In addition to various multicenter study projects in Europe and the USA, for which we act as a sponsor, we work closely with renowned international study partners in a variety of multi- and mono-centric projects to make the use of the CytoSorb therapy even more effective and targeted.

Moreover, a large international registry, managed at the highest scientific level will systematically provide important insights into safety and effects of the therapy in the clinical routine.