The recording of the CytoSorbents Symposium at the EuroELSO
chaired by Roberto Lorusso and Federico Pappalardo.
Use of CytoSorb hemoadsorption for the management of acute liver failure
Dr. Vinod Singh
Institute of Critical Care Medicine, Sir Gangaram Hospital, New Delhi, India
This case reports on a 28-year-old female patient who was referred intubated and ventilated from an intensive care unit (ICU) of another tertiary care hospital to Sir Gangaram Hospital, Delhi, with a confirmed diagnosis of acute liver failure with grade II hepatic encephalopathy and coagulopathy.
The CytoSorb whole blood adsorber is designed to remove excessive levels of cytokines, and/or bilirubin and/or myoglobin and intraoperatively during cardio-pulmonary bypass (CPB) surgery, the P2Y12-Inhibitor ticagrelor and/or Factor Xa-Inhibitor rivaroxaban.
It has also been observed in clinical studies that, when used as intended, other hydrophobic substances of medium molecular size, such as free hemoglobin and various bacterial enterotoxins, may be removed.
CytoSorb consists of an innovative porous polymer beads adsorption system that is shown to be biocompatible and hemocompatible without requiring difficult and labor-intensive rinsing steps prior to use.
Use of CytoSorb therapy* has been documented in patients with various types of hyperinflammatory and infectious conditions such as septic shock and systemic hyperinflammation also during or after CPB in cardiac surgery (e.g., endocarditis, aortic surgery).Other clinical conditions in which CytoSorb has been shown to help the body recover, by absorbing compounds listed on our label, include trauma, burns, pancreatitis, necrotizing fasciitis, liver failure and rhabdomyolysis.
It was observed in Clinical Studies that CytoSorb, when used as intended, can help to:
- Rapidly stabilize hemodynamic and reduce vasopressors need1)
- Reduces mortality in refractory septic shock + CRRT2)
- Deliver rapid shock reversal3)
- Reduce inflammatory mediators4)
- Reduce the bleeding risk in patients loaded with ticagrelor and/or rivaroxaban undergoing CPB surgery5)
The CytoSorb adsorber is a versatile whole blood cartridge that is compatible with many extracorporeal blood circuits: standard clinical renal replacement therapy (CRRT), continuous dialysis and hemofiltration, heart-lung machines, or it can be used as a stand-alone therapy.
The system can be easily set up in minutes and integrated into existing extracorporeal circuits without additional accessories. It operates with heparin or citrate anticoagulation to ensure/optimize smooth operation.
CytoSorb is the only adsorber approved for a treatment time per device up to 24 hours. independently by the mode of operation or the blood flow to enhance the continuity and efficacy of the treatment.
To date, more than 179,000 individual applications have been performed in more than 800 clinical settings worldwide, with the treatment being well tolerated and safe. We have not seen any adverse events in these applications.
The introduction of a new extracorporeal therapy in critical care requires maximum effort in the medical-scientific arena in order to establish evidence of safety and efficacy, but also to collect extensive knowledge regarding potential additional effects, such as interactions with established therapies. CytoSorbents is committed to 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, systematically provides important insights into safety and effects of the therapy in the clinical routine.
1)Calabrò MG et al., Artif Organs 2019_ 43(2): 189-194 | 2)Rugg C et al., Biomedicines 2020; 8(12):539 | 3)Friesecke S et al, Journal Artif Organs 2017; 20(3): 252-9
4)Träger K et al., Int J Artif Organs. 2020 Jun;43(6):422-429 | 5)Hassan K et al., Annals of Thoracic Surgery 2019;108(1):45-51