PMID- 38415021
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240229
IS  - 2639-8028 (Electronic)
IS  - 2639-8028 (Linking)
VI  - 6
IP  - 3
DP  - 2024 Mar
TI  - Sequential Extracorporeal Therapy of Pathogen Removal Followed by Cell-Directed 
      Extracorporeal Therapy in Streptococcal Toxic Shock Syndrome Refractory to 
      Venoarterial Extracorporeal Membrane Oxygenation: A Case Report.
PG  - e1058
LID - 10.1097/CCE.0000000000001058 [doi]
LID - e1058
AB  - BACKGROUND: Streptococcal toxic shock syndrome (STSS) is a fulminant complication 
      of predominantly invasive group A streptococcal infections. STSS is often 
      characterized by influenza-like symptoms, including fever, chills, and myalgia 
      that can quickly progress to sepsis with hypotension, tachycardia, tachypnea, and 
      multiple organ failure (kidney, liver, lung, or blood). Mortality can exceed 50% 
      depending on the severity of symptoms. CASE SUMMARY: Here, we describe a novel, 
      multi-extracorporeal intervention strategy in a case of severe septic shock 
      secondary to STSS. A 28-year-old woman 5 days after cesarean section developed 
      STSS with respiratory distress, hypotension, and multiple organ failure. Despite 
      conventional therapy with intubation, antibiotics, vasopressors, and fluid 
      resuscitation, her condition worsened. She was placed on venoarterial 
      extracorporeal membrane oxygenation (VA-ECMO) with subsequent initiation of 
      pathogen hemoperfusion using the Seraph 100 blood filter, followed by 
      immunomodulation with the selective cytopheretic device (SCD). No device-related 
      adverse events were observed. The patient's condition gradually stabilized with 
      discontinuation of vasopressors after 4 days, ECMO decannulation after 6 days, 
      evidence of renal recovery after 7 days, and extubation from mechanical 
      ventilation after 14 days. She was transferred to conventional hemodialysis after 
      13 days and discontinued all kidney replacement therapy 11 days later. 
      CONCLUSIONS: This is the first reported use of VA-ECMO, Seraph 100 hemoperfusion, 
      and cell-directed immunomodulation with SCD. This multimodal approach to 
      extracorporeal support represents a promising therapeutic strategy for the most 
      refractory critical care cases. Further studies are needed to assess the safety 
      and efficacy of this sequential approach.
CI  - Copyright (c) 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf 
      of the Society of Critical Care Medicine.
FAU - Amerson, Stephen J
AU  - Amerson SJ
AD  - Department of Internal Medicine, The Institute for Extracorporeal Life Support 
      and Texas Intensivist, Pulmonary, and Sleep Medicine, San Antonio, TX.
FAU - Hoffman, McKenna
AU  - Hoffman M
AD  - Department of Internal Medicine, The Institute for Extracorporeal Life Support 
      and Texas Intensivist, Pulmonary, and Sleep Medicine, San Antonio, TX.
AD  - Department of Internal Medicine, Methodist Healthcare System of San Antonio Ltd, 
      San Antonio, TX.
FAU - Abouzahr, Fadi
AU  - Abouzahr F
AD  - Department of Internal Medicine, Division of Nephrology, Renal Associates PA, San 
      Antonio, TX.
FAU - Ahmad, Mohammad
AU  - Ahmad M
AD  - Department of Internal Medicine, Division of Nephrology, San Antonio Kidney 
      Disease Center, San Antonio, TX.
FAU - Sterling, Rachel K
AU  - Sterling RK
AD  - Department of Internal Medicine, The Institute for Extracorporeal Life Support 
      and Texas Intensivist, Pulmonary, and Sleep Medicine, San Antonio, TX.
FAU - Gidwani, Hitesh
AU  - Gidwani H
AD  - Department of Internal Medicine, The Institute for Extracorporeal Life Support 
      and Texas Intensivist, Pulmonary, and Sleep Medicine, San Antonio, TX.
FAU - Sousse, Linda E
AU  - Sousse LE
AD  - Department of Internal Medicine, The Institute for Extracorporeal Life Support 
      and Texas Intensivist, Pulmonary, and Sleep Medicine, San Antonio, TX.
FAU - Dellavolpe, Jeffrey D
AU  - Dellavolpe JD
AD  - Department of Internal Medicine, The Institute for Extracorporeal Life Support 
      and Texas Intensivist, Pulmonary, and Sleep Medicine, San Antonio, TX.
LA  - eng
PT  - Case Reports
DEP - 20240226
PL  - United States
TA  - Crit Care Explor
JT  - Critical care explorations
JID - 101746347
PMC - PMC10898666
OTO - NOTNLM
OT  - acute kidney injury
OT  - case report
OT  - extracorporeal therapy
OT  - multiple organ failure
OT  - selective cytopheretic device
OT  - sepsis
OT  - shock
COIS- Dr. Dellavolpe was reimbursed for travel costs to present this case at a medical 
      conference. The other authors report no conflicts of interest.
EDAT- 2024/02/28 06:45
MHDA- 2024/02/28 06:46
PMCR- 2024/02/26
CRDT- 2024/02/28 03:56
PHST- 2024/02/28 06:46 [medline]
PHST- 2024/02/28 06:45 [pubmed]
PHST- 2024/02/28 03:56 [entrez]
PHST- 2024/02/26 00:00 [pmc-release]
AID - 10.1097/CCE.0000000000001058 [doi]
PST - epublish
SO  - Crit Care Explor. 2024 Feb 26;6(3):e1058. doi: 10.1097/CCE.0000000000001058. 
      eCollection 2024 Mar.