Adjunctive Use of CytoSorb Hemoadsorption with Sustained Low-Efficiency Dialysis (SLED) in Septic and Cardiogenic Shock with Multi-Organ Failure: A Case Report

Abstract

Background The combination of septic shock and cardiogenic shock (CS) causes extremely high mortality associated with systemic inflammation, as well as progressive multi-organ failure (MOF). Adjunct therapies for refractory shock, such as hemadsorption with CytoSorb are noninvasive extracorporeal blood purification procedures that are being developed; these are mostly investigated in combination with Continuous Renal Replacement Therapy (CRRT) or ECMO. We report on the case of a CytoSorb/BMT impregnated SLED treatment in low-income resources area.

Case A 35-year-old Bangladeshi male was admitted with complaints of sudden onset sharp chest pain, shortness of breath and diarrhea which rapidly developed into Anterior septal ST-Elevation Myocardial Infarction (STEMI) complicated by severe Cardiogenic Shock, Acute Kidney Injury (AKI), and refractory Sepsis (high procalcitonin and CRP). He was intubated, needed high dose vasopressors (inotropic x 2) and a TMP for brady-arrhythmia. Because of sustained hemodynamic instability and AKI, SLED was initiated.

Intervention and Results Given refractory, severe shock and systemic inflammation, CytoSorb hemadsorption was incorporated as an adjunct to the SLED circuit. After 3 days of concomitant CytoSorb and SLED therapy, the patient had an impressive clinical stabilization with decreased need for vasopressors, elimination of lactate and improvement in laboratory values. The patient was treated until recovered from MOF, weaned off mechanical ventilation and renal replacement therapy and discharged after 32 days with stable hemodynamics.

Conclusion In cases of combined septic and cardiogenic shock and MOF, particularly for patients with limited access to CRRT, the adjunct application of CytoSorb in combination with SLED is technically feasible and an effective therapeutic option. This is a unique combination in the context of multi-organ extraction for cardiac disease.