Cytokine Adsorption in Severe Acute Respiratory Failure Requiring Veno-Venous Extracorporeal Membrane Oxygenation

急性呼吸窘迫综合征 体外膜肺氧合 医学 细胞激素风暴 细胞因子 呼吸衰竭 麻醉 复苏 促炎细胞因子 体外 充氧 内科学 疾病 2019年冠状病毒病(COVID-19) 炎症 传染病(医学专业)
作者
Marina Rieder,Daniel Duerschmied,Timm Zahn,Corinna N. Lang,Christoph Benk,Achim Lother,Paul Biever,Christoph Bode,Tobias Wengenmayer,Dawid L. Staudacher,Alexander Supady
出处
期刊:Asaio Journal [Lippincott Williams & Wilkins]
卷期号:67 (3): 332-338 被引量:28
标识
DOI:10.1097/mat.0000000000001302
摘要

Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a last resort treatment option for patients with acute respiratory failure (acute respiratory distress syndrome [ARDS]). Cytokine adsorption has been incorporated in the management of some of these patients on an individual basis to control the imbalance of danger-associated molecular patterns and proinflammatory cytokines. However, little is known about the combination of V-V ECMO and cytokine adsorption as earlier reports contained mixed patient cohorts in terms of disease and mode of ECMO, veno-venous and veno-arterial. We here report single-center registry data of nine all-comers with severe ARDS treated with V-V ECMO and cytokine adsorption using the CytoSorb adsorber compared with a control group of nine propensity score matched patients undergoing V-V ECMO support without cytokine adsorption. Even though Respiratory ECMO Survival Prediction and PRedicting dEath for SEvere ARDS on V-V ECMO scores predicted a higher mortality in the cytokine adsorption group, mortality was numerically reduced in the patients undergoing V-V ECMO and cytokine removal compared with V-V ECMO alone. The need for fluid resuscitation and vasopressor support as well as lactate levels dropped significantly in the cytokine adsorption group within 72 hours, whereas vasopressor need and lactate levels did not decrease significantly in the control group. Therefore, our data suggest that cytokine adsorption might be beneficial in patients with severe ARDS requiring V-V ECMO support.

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