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
View our product animation to learn more about endotoxin removal and the Alteco LPS Adsorber.
Scientific articles
2 The Systemic Inflammatory Response to Cardiac Surgery: Implications for the Anesthesiologist
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