In this case report a 30-month old, 6.4 kg child, resuscitated with extracorporeal membrane oxygenation (ECMO), after a cardiac arrest during kidney transplantation surgery was additionally treated with a number of extracorporeal blood purification methods (plasma exchange – PE, CytoSorb, and lipopolysaccharide – LPS/endotoxin – adsorption), in the setting of immunosuppression therapy. Following three PE sessions, and, as the therapeutic effect was not as hoped (slight decrease in liver enzymes, and rise in inflammatory parameters), CytoSorb was started for a total of 21 hours. Use of CytoSorb resulted in a decrease in inflammatory parameters but, due to an occult and untreated infection, the inotropic requirements still increased. Once the infection was treated properly hemodynamics quickly stabilized and the patient gradually recovered and was able to be discharged from intensive care and then the hospital 116 days after his initial admission. This case report shows the successful use of multimodal extracorporeal therapies with a good patient outcome. As the authors note, the lack of response to CytoSorb therapy from a hemodynamic perspective could be seen as an indication for the need for ongoing investigation for an (as yet) unidentified infection, and is not necessarily failure of treatment.
Open-access publication: https://pubmed.ncbi.nlm.nih.gov/33384974/