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. 2020 Jun 15;8(1):21.
doi: 10.1186/s40635-020-00313-3.

Use of the CytoSorb adsorption device in MDMA intoxication: a first-in-man application and in vitro study

Affiliations

Use of the CytoSorb adsorption device in MDMA intoxication: a first-in-man application and in vitro study

Corinna N Lang et al. Intensive Care Med Exp. .

Abstract

Background: 3,4-Methylenedioxymethamphetamine (MDMA, "ecstasy") abuse is frequent, and overdosing might cause severe and eventually lethal multi-organ failure. To date, there is no causal therapy of MDMA intoxication and removal of MDMA from the circulation might be a reasonable measure to prevent adverse courses after overdosing. We present here first-in-man experience and in vitro data supporting a potential role of an adsorber device in severe MDMA overdosing.

Results: We applied a CytoSorb adsorber device in a 21-year-old male presenting with severe MDMA intoxication and multi-organ failure, including neurological impairment, hyperpyrexia, rhabdomyolysis, oliguric renal failure, liver failure, and coagulopathy with disseminated gastrointestinal and intramuscular bleeding. Use of the adsorber device was associated with a decline in MDMA concentrations in serum from 540 to 140 ng/ml within the first 24 h, a decrease of interleukin 6 and myoglobin levels, and subsequent clinical improvement. The patient was discharged from hospital after restoration of organ function and full neurological recovery. Effective elimination of MDMA by the adsorber device could be confirmed in vitro, when the device lowered MDMA concentrations to non-detectable levels.

Conclusions: We report here first-in-man experience and in vitro data showing the capacity of a CytoSorb adsorber device for MDMA removal. Early integration of CytoSorb use may enhance the management of severe MDMA intoxication, though we cannot prove whether clinical improvement was directly related to elimination of MDMA or beneficial effects on rhabdomyolysis, hyperinflammation, or liver failure. Our findings encourage further investigation of the CytoSorb adsorber device in a prospective study and to evaluate its use for other intoxications.

Keywords: Adsorption; Intoxication; MDMA; Multi-organ failure.

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Conflict of interest statement

Corinna N. Lang, Alexander Supady and Daniel Duerschmied received speaker honoraria from CytoSorbents Europe. Daniel Duerschmied received a research grant from CytoSorbents Europe. All other authors have no conflict of interest or competing interest to declare.

Figures

Fig. 1
Fig. 1
Time course of laboratory findings and treatment milestones during clinical application of the adsorber device after MDMA intoxication. Serum concentrations of interleukin 6 (IL-6), myoglobin, 3,4-methylenedioxymethamphetamine (MDMA), creatinine, sodium, bilirubin, and international normalized ratio (INR), fibrinogen levels, and aspartate amino transferase (AST) activity were repeatedly measured during the clinical course. MELD score (Model of End-Stage Liver Disease) was calculated to assess liver injury (a). Timeline indicating durations of mechanical ventilation (purple), external cooling (mid-blue), continuous renal replacement therapy (CRRT) with CytoSorb (light-blue), and intermittent renal replacement therapy (IRRT, dashed light-blue) (b)
Fig. 2
Fig. 2
Adsorption of MDMA in vitro. Serum containing 3,4-methylenedioxymethamphetamine (MDMA-FCS, 1 μg/ml) was circulated from a reservoir at a flow rate of 170 ml/min (a). MDMA-FCS samples were taken from the circuit before (pre, red) and after (post, blue) the adsorber device at 0, 5, 10, 15, 30, and 60 min, and MDMA was quantified by HPLC (b). Dashed line indicates calculated half-life

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