Endotoxin from gram-negative bacteria is a potent trigger of the inflammatory response, and endotoxemia is known to occur in cardiac surgery using extracorporeal circulation. 1 High endotoxin levels correlate with a significantly higher risk of postoperative infection and cardiovascular dysfunction following cardiopulmonary bypass (CPB). 2, 3
The gut is a source of gram-negative bacteria and endotoxin
Translocation of gram-negative bacteria from the gut to the bloodstream can cause severe symptoms of endotoxemia and sepsis. Several factors impact the risk of translocation:
• long clamping times (>90 minutes), for instance in CPB
• splanchnic hypoperfusion may damage the mucosal barrier, increasing intestinal permeability 5
• a systemic inflammatory reaction that is induced when blood comes into contact with large artificial surfaces such as in a CPB circuit 6
• intestinal injury through intestinal ischemia–reperfusion 7
Preventive endotoxin removal with Alteco LPS Adsorber
Implementing the Alteco LPS Adsorber in Heart- and Lung machine (HLM) can have benefits through preventive elimination of endotoxin. Removing endotoxin may assist to avoid postsurgical complications and organ damage, thus paving the way for a faster recovery. 8,9,10
Intra-operative use of Alteco LPS Adsorber during CPB is safe, without lower platelet count or bleeding. Alteco LPS Adsorber reduces the levels of endotoxin resulting in reduced peripheral lactate levels, reduced procalcitonin and improved tissue perfusion. Positive effects have also been seen on leukocytosis levels, body temperature, hemodynamic indices, and lung oxygenating function. 11,12
Take endotoxin out of the picture!
More about endotoxin and cardiac surgery
Thirteen patients with gram-negative sepsis underwent the procedure of selective lipopolysaccharide adsorption using Alteco LPS Adsorber (group I) or Toraymyxin columns (group II). This therapy positively influenced the course of sepsis. After the second procedure, levels of serum endotoxin and procalcitonin markedly decreased in both groups. We also discovered a positive effect on leukocytosis levels and a trend towards normalization of body temperature, improvement of hemodynamic indices and increase of the lung's oxygenating function. Blood cultures taken several days after the procedure were negative.
No adverse events were encountered when the Alteco LPS Adsorber was used in the circuit. Blood flow through the device was easily monitored and kept at the desired level. The Alteco LPS Adsorber can be used safely and is easy to handle in the bypass circuit. No complications related to the use of the device were noted.
1 Clinical experience with a novel endotoxin adsorbtion device in patients undergoing cardiac surgery
2 The Systemic Inflammatory Response to Cardiac Surgery: Implications for the Anesthesiologist
3 Endotoxemia related to cardiopulmonary bypass is associated with increased risk of infection after cardiac surgery: a prospective observational study.
4 Prolonged Cardiopulmonary Bypass is a Risk Factor for Intestinal Ischaemic Damage and Endotoxaemia
5 The Systemic Inflammatory Response to Cardiac Surgery, Implications for the Anesthesiologist
6 Sepsis After Cardiac Surgery: From Pathophysiology to Management
7 Prolonged Cardiopulmonary Bypass is a Risk Factor for Intestinal Ischaemic Damage and Endotoxaemia
8 Risk factors of sepsis after open congenital cardiac surgery in infants: A pilot study
9 Prolonged Cardiopulmonary Bypass is a Risk Factor for Intestinal Ischaemic Damage and Endotoxaemia
10 Endotoxemia and Mediator Release During Cardiac Surgery
11 Effects of early use of Alteco LPS Adsorber in Acute Aortic Dissection Type A: Preliminary results
12 Preliminary report regarding the use of selective sorbents in complex cardiac surgery patients with extensive sepsis and prolonged intensive care stay