Case report: Cytokine hemoadsorption in a case of hemophagocytic lymphohistiocytosis secondary to extranodal NK/T-cell lymphoma

Cytokine hemoadsorption; Hemophagocytic lymphohistiocytosis; Multiorgan dysfunctionHemoadsorció de citocines; Limfohistiocitosi hemofagocítica; Disfunció multiorgànicaHemoadsorción de citoquinas; Linfohistiocitosis hemofagocítica; Disfunción multiorgánicaWe discuss a single case of Hemophagocytic lymphohistiocytosis (HLH) due to NK-type non-Hodgkin lymphoma and Epstein-Barr virus reactivation with multiorgan dysfunction and distributive shock in which we performed cytokine hemoadsorption with Cytosorb ®. A full microbiological panel was carried out, including screening for imported disease, standard serologies and cultures for bacterial and fungal infection. A liver biopsy and bone marrow aspirate were performed, confirming the diagnosis. The patients fulfilled the HLH-2004 diagnostic criteria, and according to the 2018 Consensus Statements by the HLH Steering Committee of the Histiocyte Society, dexamethasone and etoposide were started. There was an associated hypercytokinemia and, due to refractory distributive shock, rescue therapy with cytokine hemoadsorption was performed during 24 h (within day 2 and 3 from ICU admission). After starting this procedure, rapid hemodynamic control was achieved with a significant reduction in vasopressor support requirements. This case report highlights that cytokine hemoadsorption can be an effective since rapid decrease in IL-10 levels and a significant hemodynamic improvement was achieved

Pulmonary Air Embolism in a Patient with COVID-19 with Extracorporeal Membrane Oxygenation Support

Embòlia aèria pulmonar; COVID-19Embolia aérea pulmonar; COVID-19Pulmonary air embolism; COVID-1

Coagulation management in patients requiring extracorporeal membrane oxygenation support: a comprehensive narrative review

Anticoagulation; Extracorporeal life support; ThrombosisAnticoagulación; Soporte vital extracorpóreo; TrombosisAnticoagulació; Suport vital extracorpòri; TrombosiBackground and Objective: Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy to support respiratory or cardiorespiratory function in critically ill patients when conventional treatments fail. The exposure of the patient’s blood components to the foreign surface of the ECMO extracorporeal circuit activates the inflammatory and coagulation cascades. Systemic anticoagulation is generally required to prevent thrombotic complications, assuming an increased risk of patient bleeding. Despite the increased biocompatibility of novel ECMO devices, the variety of anticoagulation drugs, and the different anticoagulation monitoring tools, there is no gold-standard hemostasis management in patients with extracorporeal life support (ECLS). We aimed to describe the underlying physiology as a rationale for the need for anticoagulation in ECMO. To describe the different alternatives for anticoagulation management, bleeding prevention, and the specific management of anticoagulation in different subgroups of patients, including coronavirus disease 2019 (COVID-19) patients. Methods: We conducted a comprehensive literature search in the main databases, including Cochrane Database, PubMed, Google Scholar, CINAHL, and Scopus databases, with no start date until December 1st, 2023. We reviewed articles written in English and Spanish. Key Content and Findings: Evolving evidence has been changing the current practices on anticoagulation in ECMO, and novel alternatives are available to decrease the bleeding risk in high-risk patients and for the management of bleeding complications. Conclusions: Anticoagulation practices in ECMO are ubiquitous though variable among different geographic areas. However, as clinical experience in ECMO patients increases, best practices can be reproduced among different settings to improve patient management and patient outcomes. Some challenges remain regarding the best anticoagulation strategy in specific groups of patients