International registry on the use of the CytoSorb® adsorber in ICU patients : Study protocol and preliminary results.

INTRODUCTION: The aim of this clinical registry is to record the use of CytoSorb® adsorber device in critically ill patients under real-life conditions. METHODS: The registry records all relevant information in the course of product use, e. g., diagnosis, comorbidities, course of the condition, treatment, concomitant medication, clinical laboratory parameters, and outcome (ClinicalTrials.gov Identifier: NCT02312024). Primary endpoint is in-hospital mortality as compared to the mortality predicted by the APACHE II and SAPS II score, respectively. RESULTS: As of January 30, 2017, 130 centers from 22 countries were participating. Data available from the start of the registry on May 18, 2015 to November 24, 2016 (122 centers; 22 countries) were analyzed, of whom 20 centers from four countries provided data for a total of 198 patients (mean age 60.3 ± 15.1 years, 135 men [68.2%]). In all, 192 (97.0%) had 1 to 5 Cytosorb® adsorber applications. Sepsis was the most common indication for CytoSorb® treatment (135 patients). Mean APACHE II score in this group was 33.1 ± 8.4 [range 15-52] with a predicted risk of death of 78%, whereas the observed mortality was 65%. There were no significant decreases in the SOFA scores after treatment (17.2 ± 4.8 [3-24]). However interleukin-6 levels were markedly reduced after treatment (median 5000 pg/ml before and 289 pg/ml after treatment, respectively). CONCLUSIONS: This third interim report demonstrates the feasibility of the registry with excellent data quality and completeness from 20 study centers. The results must be interpreted with caution, since the numbers are still small; however the disease severity is remarkably high and suggests that adsorber treatment might be used as an ultimate treatment in life-threatening situations. There were no device-associated side effects.

Inter-hospital transfer of ECMO-assisted patients with a portable miniaturized ECMO device: 4 years of experience.

OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) in patients with severe pulmonary failure is able to keep patients alive until organ regeneration, until shunting out for further diagnostic and therapeutic options or until transportation to specialized centers. Nonetheless, extracorporeal techniques require a high degree of expertise, so that a confinement to specialized centers is meaningful. Following from this requirement, the need for inter-hospital transfer of patients with severely compromised pulmonary function is rising. METHODS: We report about our experience with a portable ECMO system during inter-hospital air or ground transfer of patients with cardiopulmonary failure. RESULTS: The portable ECMO system was used for transportation to the center and in-hospital treatment in 36 patients with an average age of 53 years suffering from respiratory failure. Accordingly, the ECMO system was implanted as a veno-venous extracorporeal system. Pre-ECMO ventilation time was 5.2 (2-9) days. Twelve patients were transported to our institution by ground and 24 patients by air ambulance over a median distance of 46 km. With the assistance of the ECMO device, prompt stabilization of cardiopulmonary function could be achieved in all patients without any technical complications. Post-ECMO ventilation was 9.8 days. Weaning from the ECMO system was successful in 61% of all patients after a median device working period of 12.7 days; median ICU stay was 34 days and a survival rate of 64% of patients was achieved. Technical (8%) and device-associated bleeding (11%)/thromboembolic (8%) complication rates showed very acceptable levels. CONCLUSION: Our experience demonstrates that miniaturized, portable ECMO therapy allows location-independent, out-of-center stabilization of pulmonary compromised patients with consecutive inter-hospital transfer and further in-house treatment, so that sophisticated ECMO therapy can be offered to every patient, even in hospitals with primary healthcare.

Quantitative analysis of aggregation in dilute solutions of effectively rigid biomacromolecules via the combination of oscillatory flow birefringence and viscoelasticity measurements: example study of aggregation of bovine fibrinogen in aqueous glycerol, and detection of a large aggregate formed on addition of guanidine hydrochloride.

Oscillatory flow birefringence (OFB) properties have been measured for dilute solutions of bovine fibrinogen in 65-68% aqueous glycerol with the Miller-Schrag Thin Fluid Layer (TFL) apparatus employing either titanium or stainless steel surfaces in contact with the solutions. The shearing frequency range was 1 to 2500 Hz, the concentrations ranged from 4 to 8 mg/ml, and measurement temperatures were 9.9, 10.0, and 15.8 degrees C. The data showed evidence of significant amounts of aggregation that apparently is caused by the presence of glycerol; contributions from the various aggregates were readily detected since the staggered half-overlap aggregation in this system results in substantial differences in the rotational relaxation times of the various effectively rigid aggregates. The combination of oscillatory flow birefringence and viscoelasticity (VE) data provided sensitive and precise characterization of aggregation in these example systems; all aggregates exhibited the expected positive optical anisotropy. The length of unaggregated fibrinogen in solution was found to be that obtained via electron microscopy. Addition of guanidine hydrochloride to hopefully reduce aggregation did so but also resulted in formation of a very large (2800 to 3500 A), apparently nearly monodisperse, negatively birefringent aggregate, suggesting that this new species might be formed by lateral aggregation.

Analysis of fibrous network fluid permeation data using the theory of ultracentrifugation: application to fibrin gels.

A new and alternative method for calculating the strand diameter of fibrous gel networks from fluid permeation data is developed and used to analyze and compare previous Darcy constant measurements of fibrin gels. The calculated diameters from the various sets of experimental data using this method gives for a coarse fibrin clot a strand diameter of approximately 1000 A and for a fine fibrin clot a strand diameter of 170 A.

Flexibility of myosin rod determined from dilute solution viscoelastic measurements.

The frequency dependencies of the storage and loss shear moduli, G' and G", of myosin rod solutions at 1.0 and 7.0 degrees C were measured by use of the Birnboim-Schrag multiple lumped resonator apparatus in solvents with and without glycerol. The infinite dilution moduli were determined and compared with theoretical models for a rigid rod and a freely jointed trinodular rod and with an empirical model for a semiflexible rod. Only the latter could fit the data. A rotational relaxation time of 25 mus and a slowest bending time of 3.1 mus, both reduced to water at 20 degrees C, were determined from the fit. A persistence length of about 130 nm was obtained from either the bending time, the rotational relaxation time, or the intrinsic viscosity. The average thermal excursion of the end of subfragment 2 was estimated to be 26 nm, more than sufficient to span the gap between the thick and thin filaments in muscles at all sarcomere lengths. Thus, a hinge between heavy meromyosin and light meromyosin does not appear necessary for myosin-actin contact. Young's modulus of about 1 x 10(9) N/m2 also makes it unlikely that subfragment 2 can be the elastic element in the Huxley-Simmons model of muscle contraction.