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 4
• 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

Treatment results

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