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The following is a summary of “Myoglobin adsorption and saturation kinetics of the cytokine adsorber Cytosorb® in patients with severe rhabdomyolysis: a prospective trial,” published in the June 2024 issue of Critical Care by Graf et al.

Rhabdomyolysis can result in acute kidney injury necessitating renal replacement therapy (RRT), and while Cytosorb® (CS) is employed for extracorporeal myoglobin elimination in such cases, data on its adsorption capacity and saturation kinetics remain uncertain.

Researchers conducted a prospective study investigating the capacity and saturation kinetics of CS for removing myoglobin in patients with rhabdomyolysis.

They included 20 patients in ICU with severe rhabdomyolysis (myoglobin levels exceeding 5000 ng/ml) requiring RRT for acute kidney injury. Blood samples were collected and analyzed for myoglobin and creatine kinase (CK) at specific time points before CS use and 10 minutes, 1 hour, 3 hours, 6 hours, and 12 hours after treatment initiation. The Relative Change (RC, %) was calculated with:  

1-(concentration(pre-post)/concentration(pre))*100. While Myoglobin plasma clearances (ml/min) were calculated by (blood flow*(1-hematocrit))*(concentration(pre-post)/concentration(pre))*100

The result showed that median plasma myoglobin concentration after 6 hours of installation of CS dropped from a very high level of (median (IQR) 56,894 ng/ml (11,544; 102,737 ng/ml) to 40,125 ng/ml (7879; 75,638 ng/ml) (P<0.001). No notable changes were observed after twelve hours. The CS showed a substantial capacity for myoglobin removal at all measured time points (10 minutes, 1 hour, 3 hours, 6 hours, and 12 hours). The median (IQR) reduction coefficients (RC) of myoglobin were -79.2% (-85.1; -47.1%) at 10, -34.7% (-42.7; -18.4%) at 1 hour, -16.1% (-22.1; -9.4%) at 3 hours, -8.3% (-7.5; -1.3%) at 6 hours, and -3.9% (-3.9; -1.3%) at 12 hours. Additionally, the median myoglobin plasma clearance dropped from 64.0 ml/min (IQR 58.6–73.5 ml/min) 10 minutes after starting CS treatment to 29.1 ml/min (IQR 26.5–36.1 ml/min) at 1 hour, 16.1 ml/min (IQR 11.9–22.5 ml/min) at 3 hours, 7.9 ml/min (IQR 5.5–12.5 ml/min) at 6 hours, and 3.7 ml/min (IQR 2.4–6.4 ml/min) at 12 hours.

Investigators concluded that CS effectively removed myoglobin in rhabdomyolysis, but the capacity diminishes rapidly, suggesting earlier replacement might improve efficacy. 

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01334-x