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- Dokumenttyp:
- Article; Case Reports; Journal Article
- Autor(en):
- Huber, Wolfgang; Lorenz, Georg; Heilmaier, Markus; Böttcher, Katrin; Sahm, Philipp; Middelhoff, Moritz; Ritzer, Barbara; Schulz, Dominik; Bekka, Elias; Hesse, Felix; Poszler, Alexander; Geisler, Fabian; Spinner, Christoph; Schmid, Roland M; Lahmer, Tobias
- Titel:
- Extracorporeal multiorgan support including CO2-removal with the ADVanced Organ Support (ADVOS) system for COVID-19: A case report.
- Abstract:
- A substantial part of COVID-19-patients suffers from multi-organ failure (MOF). We report on an 80-year old patient with pulmonary, renal, circulatory, and hepatic failure. We decided against the use of extracorporeal membrane oxygenation (ECMO) due to old age and a SOFA-score of 13. However, the patient was continuously treated with the extracorporeal multi-organ- "ADVanced Organ Support" (ADVOS) device (ADVITOS GmbH, Munich, Germany). During eight 24h-treatment-sessions blood flow (100-300 mL/min), dialysate flow (160-320 mL/min) and dialysate pH (7.6-9.0) were adapted to optimize arterial PaCO2 and pH. Effective CO2 removal and correction of acidosis could be demonstrated by mean arterial- versus post-dialyzer values of pCO2 (68.7 ± 13.8 vs. 26.9 ± 11.6 mmHg; p < 0.001). The CO2-elimination rate was 48 ± 23mL/min. The initial vasopressor requirement could be reduced in parallel to pH-normalization. Interruptions of ADVOS-treatment repeatedly resulted in reversible deteriorations of paCO2 and pH. After 95 h of continuous extracorporeal decarboxylating therapy the patient had markedly improved circulatory parameters compared to baseline. In the context of secondary pulmonary infection and progressive liver failure, the patient had a sudden cardiac arrest. In accordance with the presumed patient will, we decided against mechanical resuscitation. Irrespective of the outcome we conclude that extracorporeal CO2 removal and multiorgan-support were feasible in this COVID-19-patient. Combined and less invasive approaches such as ADVOS might be considered in old-age-COVID-19 patients with MOF.
- Zeitschriftentitel:
- Int J Artif Organs
- Jahr:
- 2021
- Band / Volume:
- 44
- Heft / Issue:
- 4
- Seitenangaben Beitrag:
- 288-294
- Volltext / DOI:
- doi:10.1177/0391398820961781
- PubMed:
- http://view.ncbi.nlm.nih.gov/pubmed/32985328
- Print-ISSN:
- 0391-3988
- TUM Einrichtung:
- Fachgebiet Nephrologie (Prof. Heemann); II. Medizinische Klinik und Poliklinik (Gastroenterologie)
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