PMC8232055_01
Upper section: Time course of B-type natriuretic peptide (pro-BNP) and lactate during extracorporeal blood purification treatment (EBPT). Blue dashed line refers to the normal value of pro-BNP (<360 pg/ml); red dashed line refers to the normal value of lactate (<2 mmol/L). Lower section: Time course of the ejection fraction during EBPT and in the following days after stopping adrenaline, milrinone, and hemoperfusion.
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F1
An echocardiogram performed 12 h after the start of the blood purification showed an improvement of her ejection fraction (EF = 45%) and complete normalization by 24 h (EF = 60%) (Figure 1). Pro-BNP progressively improved over the following 3 days (Figure 1), and epinephrine infusion was able to be progressively reduced and totally stopped on day 3 and milrinone on day 7.
Time course of interleukin 6, interleukin 10, C-reactive protein (CRP), D-dimers, and ferritin during extracorporeal blood purification treatment.
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F2
The D-dimer, CRP, and ferritin all decreased as the ejection fraction improved, and vasopressors were weaned off (Figure 2). The same time course was observed for IL-6 and IL-10 blood levels that were measured every 24 h during the blood purification treatment (Figure 2).
Values of the most important microcirculation parameters related to microvascular flow and capillary density at different time points during extracorporeal blood purification treatment: microvascular flow index (MFI), mean flow index small vessels (MFI small), heterogeneity index (HI), De Backer score, total small vessel density (TVD), proportion of perfused vessels (PPV), and perfused microvascular density (PVD).
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F3
In Figure 3, we report the microcirculation parameters at different time points.
Clinical timeline of a 14-year-old girl diagnosed with SARS-CoV-2-related multisystem inflammatory syndrome with severe myocardial dysfunction and refractory shock. The timeline shows the time course of the clinical evolution and the timing of the multimodal therapeutic approach based on immunomodulatory drugs and extracorporeal blood purification with continuous renal replacement therapy (CRRT) plus CytoSorb hemoperfusion.
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F4
Figure 4 shows a timeline of our patient's clinical journey.