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Hemoadsorption for severe MIS-C in critically ill children, should we consider it as a therapeutic opportunity?
Gabriella Bottari1, Flavia Severini2, Anna Hermine Markowich2
1Pediatric Intensive Care Unit, Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Insights
Multisystem inflammatory syndrome in children (MIS-C) can cause severe heart problems. Hemoadsorption therapy, using CytoSorb, helped stabilize a critically ill adolescent with MIS-C, controlling inflammation and improving heart function.
Area of Science:
- Pediatrics
- Cardiology
- Infectious Diseases
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a severe condition linked to COVID-19, often affecting the cardiovascular system.
- MIS-C can lead to significant left ventricular dysfunction (LVD) and shock, requiring intensive support.
- Current mortality rates for MIS-C range from 1.5% to 1.9%.
Purpose of the Study:
- To present the clinical experience of using hemoadsorption as an adjunctive therapy in a pediatric patient with refractory shock due to MIS-C.
- To evaluate the safety and efficacy of hemoadsorption combined with continuous kidney replacement therapy (CKRT) and immunomodulatory treatments.
- To analyze and compare recent evidence on hemoadsorption for severe MIS-C cases.
Main Methods:
- Case report of an adolescent with MIS-C and refractory shock treated with hemoadsorption (CytoSorb) and CKRT.
- Combination therapy included immunomodulatory agents.
- Review and comparison of existing literature on hemoadsorption in severe MIS-C.
Main Results:
- The combined therapeutic strategy led to hemodynamic and clinical stabilization.
- Hyperinflammatory response was effectively controlled.
- Treatment was observed to be safe and feasible, potentially avoiding the need for ECMO.
Conclusions:
- Hemoadsorption therapy, particularly with CytoSorb, shows promise as an adjunctive treatment for severe MIS-C with cardiovascular involvement.
- This blood purification strategy may help manage the cytokine storm and severe left ventricular dysfunction in MIS-C.
- Further research and clinical trials are warranted to confirm the role of hemoadsorption in pediatric critical care for MIS-C.
Abstract:
Multisystem inflammatory syndrome (MIS-C) is a new severe clinical condition that has emerged during the COVID-19 pandemic. MIS-C affects children and the young usually after a mild or asymptomatic COVID-19 infection. MIS-C has a high tropism for the cardiovascular system with need for inotropes and vasopressor support in 62% of cases. As of today a mortality from 1.5% to 1.9% related to MIS-C is reported. Hemoadsorption via the inflammatory mediator adsorber CytoSorb (CytoSorbents Europe, Berlin Germany) has been used as adjunctive therapy with the aim to restore the host response in septic shock and other hyper-inflammatory syndromes. We present the clinical experience of an adolescent boy with a refractory shock secondary to left ventricular dysfunction (LVD) in the context of MIS-C, treated with hemoadsorption, and continuous kidney replacement therapy (CKRT) in combination with immunomodulatory therapies. The therapeutic strategy resulted in hemodynamic and clinical stabilization as well as control of the hyperinflammatory response. Treatment appeared to be safe and feasible. Our findings are in line with previously published clinical cases on Cytosorb use in MIS-C showing the beneficial role of the hemoperfusion with Cytosorb in severe MIS-C to manage the cytokine storm. We provide an analysis and comparison of recent evidence on the use of hemoadsorption as an adjuvant therapy in critically ill children with severe forms of MIS-C, suggesting this blood purification strategy could be a therapeutic opportunity in severe LVD due to MIS-C, sparing the need for extracorporeal membrane oxygentation (ECMO) and other mechanical cardiocirculatory supports.
