CytoSorbents Corporation presented on their flagship product CytoSorb, a cytokine filter approved in the EU. CytoSorb aims to reduce cytokine storm in critical illnesses like sepsis by filtering cytokines from blood. Clinical trials showed CytoSorb safely reduced cytokines and mortality in sepsis patients. The company is launching CytoSorb in Germany and developing applications in trauma, transfusion, and dialysis through strategic partnerships. CytoSorbents aims to address major unmet needs in critical care markets exceeding $10 billion annually.
The document discusses the use of Cytosorb therapy in cardiac surgery to reduce inflammation and improve outcomes. It provides examples of how Cytosorb therapy has been used preventatively and therapeutically in various cardiac surgery cases and procedures. The evidence presented includes in vitro studies as well as retrospective clinical case studies that demonstrate reductions in inflammatory markers, organ dysfunction, bleeding, and transfusions with Cytosorb therapy. Larger, prospective randomized controlled trials are still needed to provide higher levels of evidence on the efficacy, safety and appropriate applications of Cytosorb therapy in cardiac surgery.
Angiotensin receptor-neprilysin inhibition(ARNI):The New Fronteir ?drucsamal
1) LCZ696, which inhibits neprilysin and blocks angiotensin receptors, reduced the risks of cardiovascular death and heart failure hospitalization compared to enalapril in patients with heart failure with reduced ejection fraction.
2) LCZ696 also reduced the risks of all-cause mortality and worsened heart failure compared to enalapril.
3) Patients receiving LCZ696 experienced greater improvements in quality of life and functional status measures compared to those receiving enalapril.
PCSK9 inhibitors are a new class of drugs for lowering LDL cholesterol by inhibiting the PCSK9 protein. They have been shown to reduce LDL levels by 40-72% as monotherapy or in combination with statins. While clinical trials have demonstrated excellent safety and efficacy, their high cost remains a limitation. Current guidelines recommend PCSK9 inhibitors as a second-line option for patients who cannot reach LDL goals despite maximal statin therapy or who are statin intolerant.
SCAD is a rare, sometimes fatal, traumatic condition with approximately eighty percent of cases affecting women. The coronary artery can suddenly develop a tear, causing blood to flow between the layers which forces them apart, potentially causing a blockage of blood flow through the artery and a resulting heart attack. The condition may be related to female hormone levels, as it is often seen in post-partum women, or in women during or very near menstruation, but not always. It is not uncommon for SCAD to occur in people in good physical shape and with no known prior history of heart related illness. It is also not uncommon for SCAD to occur in people in their 20's, 30's, and 40's, as well as older.
Percutaneous circulatory support. iabp, impella and beyonddrucsamal
1) Percutaneous circulatory support devices like IABP, Impella and LVADs can provide hemodynamic support in cardiogenic shock, but their effects on mortality are unclear from randomized trials.
2) While LVADs provide better hemodynamic support than IABP, they also have higher risks of complications like bleeding and limb ischemia. Trials comparing IABP to medical management alone found no significant difference in mortality.
3) Revascularization through PCI or CABG within 36 hours appears to reduce mortality compared to medical stabilization alone for cardiogenic shock patients.
The document discusses various clinical trials related to cardiovascular diseases. It summarizes the ACCORD BP study which found that targeting a SBP of <120 mm Hg compared to <140 mm Hg in patients with type 2 diabetes did not reduce cardiovascular events. It also summarizes the HOPE trial which found that ramipril reduced cardiovascular deaths, myocardial infarction, and stroke in high-risk patients without low ejection fraction or heart failure. Finally, it summarizes the EUROPA trial which found that perindopril reduced the primary endpoint of cardiovascular mortality, non-fatal MI, and cardiac arrest in patients with stable coronary artery disease.
This document discusses challenging cases of acute heart failure involving diuretic resistance. It begins by defining diuretic resistance as a poor response to diuretic therapy, characterized by persistent signs and symptoms despite treatment. The pathophysiology of diuretic resistance is incompletely understood but may involve factors like RAAS activation, decreased renal function and blood flow, and distal tubular sodium reabsorption. The document reviews potential treatments for diuretic resistance including increasing and switching diuretic medications, adding mineralocorticoid receptor antagonists or thiazides, intravenous diuretic administration, and in select cases ultrafiltration. Early identification of diuretic resistance is important and associated with worse patient outcomes.
- The EMPHASIS-HF trial studied the effects of adding eplerenone versus placebo to evidence-based heart failure therapy in 2737 patients with systolic heart failure and mild symptoms.
- Patients taking eplerenone experienced a 37% reduced risk of the primary composite endpoint of cardiovascular death or heart failure hospitalization compared to placebo.
- Eplerenone treatment was also associated with reduced risk of all-cause mortality compared to placebo.
- The trial was stopped early based on a recommendation from the data safety monitoring board due to clear benefits of eplerenone beyond prespecified stopping boundaries.
The document discusses the use of Cytosorb therapy in cardiac surgery to reduce inflammation and improve outcomes. It provides examples of how Cytosorb therapy has been used preventatively and therapeutically in various cardiac surgery cases and procedures. The evidence presented includes in vitro studies as well as retrospective clinical case studies that demonstrate reductions in inflammatory markers, organ dysfunction, bleeding, and transfusions with Cytosorb therapy. Larger, prospective randomized controlled trials are still needed to provide higher levels of evidence on the efficacy, safety and appropriate applications of Cytosorb therapy in cardiac surgery.
Angiotensin receptor-neprilysin inhibition(ARNI):The New Fronteir ?drucsamal
1) LCZ696, which inhibits neprilysin and blocks angiotensin receptors, reduced the risks of cardiovascular death and heart failure hospitalization compared to enalapril in patients with heart failure with reduced ejection fraction.
2) LCZ696 also reduced the risks of all-cause mortality and worsened heart failure compared to enalapril.
3) Patients receiving LCZ696 experienced greater improvements in quality of life and functional status measures compared to those receiving enalapril.
PCSK9 inhibitors are a new class of drugs for lowering LDL cholesterol by inhibiting the PCSK9 protein. They have been shown to reduce LDL levels by 40-72% as monotherapy or in combination with statins. While clinical trials have demonstrated excellent safety and efficacy, their high cost remains a limitation. Current guidelines recommend PCSK9 inhibitors as a second-line option for patients who cannot reach LDL goals despite maximal statin therapy or who are statin intolerant.
SCAD is a rare, sometimes fatal, traumatic condition with approximately eighty percent of cases affecting women. The coronary artery can suddenly develop a tear, causing blood to flow between the layers which forces them apart, potentially causing a blockage of blood flow through the artery and a resulting heart attack. The condition may be related to female hormone levels, as it is often seen in post-partum women, or in women during or very near menstruation, but not always. It is not uncommon for SCAD to occur in people in good physical shape and with no known prior history of heart related illness. It is also not uncommon for SCAD to occur in people in their 20's, 30's, and 40's, as well as older.
Percutaneous circulatory support. iabp, impella and beyonddrucsamal
1) Percutaneous circulatory support devices like IABP, Impella and LVADs can provide hemodynamic support in cardiogenic shock, but their effects on mortality are unclear from randomized trials.
2) While LVADs provide better hemodynamic support than IABP, they also have higher risks of complications like bleeding and limb ischemia. Trials comparing IABP to medical management alone found no significant difference in mortality.
3) Revascularization through PCI or CABG within 36 hours appears to reduce mortality compared to medical stabilization alone for cardiogenic shock patients.
The document discusses various clinical trials related to cardiovascular diseases. It summarizes the ACCORD BP study which found that targeting a SBP of <120 mm Hg compared to <140 mm Hg in patients with type 2 diabetes did not reduce cardiovascular events. It also summarizes the HOPE trial which found that ramipril reduced cardiovascular deaths, myocardial infarction, and stroke in high-risk patients without low ejection fraction or heart failure. Finally, it summarizes the EUROPA trial which found that perindopril reduced the primary endpoint of cardiovascular mortality, non-fatal MI, and cardiac arrest in patients with stable coronary artery disease.
This document discusses challenging cases of acute heart failure involving diuretic resistance. It begins by defining diuretic resistance as a poor response to diuretic therapy, characterized by persistent signs and symptoms despite treatment. The pathophysiology of diuretic resistance is incompletely understood but may involve factors like RAAS activation, decreased renal function and blood flow, and distal tubular sodium reabsorption. The document reviews potential treatments for diuretic resistance including increasing and switching diuretic medications, adding mineralocorticoid receptor antagonists or thiazides, intravenous diuretic administration, and in select cases ultrafiltration. Early identification of diuretic resistance is important and associated with worse patient outcomes.
- The EMPHASIS-HF trial studied the effects of adding eplerenone versus placebo to evidence-based heart failure therapy in 2737 patients with systolic heart failure and mild symptoms.
- Patients taking eplerenone experienced a 37% reduced risk of the primary composite endpoint of cardiovascular death or heart failure hospitalization compared to placebo.
- Eplerenone treatment was also associated with reduced risk of all-cause mortality compared to placebo.
- The trial was stopped early based on a recommendation from the data safety monitoring board due to clear benefits of eplerenone beyond prespecified stopping boundaries.
1) Prosthetic heart valve thrombosis can occur with both mechanical and biological valves and is influenced by surface factors, hemodynamic factors, and hypercoagulability.
2) Clinical presentation may include heart failure symptoms or embolic events, and imaging with TEE is the standard for evaluation.
3) Treatment depends on severity of symptoms and includes anticoagulation, fibrinolytic therapy, or emergency surgery for severe cases.
A ventricular assist device (VAD) is a mechanical pump that helps the ventricles pump blood through the body. VADs are used to treat heart failure and cardiogenic shock. They can partially or completely replace the function of a failing heart. VADs are designed to assist the right ventricle, left ventricle, or both ventricles. Common uses of VADs include bridging patients to transplant, bridging to recovery or decision, and destination therapy for patients who are not eligible for transplant. Complications of VAD therapy include bleeding, infection, thromboembolism, device malfunction, and right heart failure.
Left ventricular assist devices (LVADs) are mechanical pumps that are used to support heart function in patients with heart failure. There are several indications for LVAD support including bridging patients to cardiac transplantation, bridging to decision about transplantation eligibility, as destination (permanent) therapy for those ineligible for transplantation, and bridging to potential heart recovery. LVADs improve symptoms and survival in advanced heart failure patients and can allow some to recover enough to no longer require support or become eligible for transplantation. Newer continuous flow LVAD designs have improved outcomes compared to older pulsatile devices.
This document discusses various inotropic and vasoactive drugs used for hemodynamic support. It provides details on the mechanisms of action, indications, dosing and side effects of drugs like adrenaline, noradrenaline, dopamine, dobutamine, milrinone, levosimendan, phenylephrine, vasopressin, isoprenaline, nitroglycerine and sodium nitroprusside. The effects of these drugs on parameters like cardiac output, systemic vascular resistance, blood pressure, heart rate and preload/afterload are summarized. Constitution, typical dosing and infusion rates are also outlined. The document concludes with a table on the hemodynamic management plan for various conditions like hypovole
1) The document discusses the role of cardiac resynchronization therapy (CRT) in treating chronic heart failure based on results from clinical trials.
2) Landmark trials like CARE-HF, MADIT-CRT and REVERSE showed that CRT reduces mortality and hospitalization in patients with heart failure symptoms.
3) Later trials also found benefits of CRT in mildly symptomatic patients with reduced left ventricular function and wide QRS duration, including decreased heart failure events and increased left ventricular ejection fraction, though effects on quality of life and exercise capacity were less clear.
This document discusses cardioplegia and surgical ischemia. It provides an overview of ischemic injury including acute ischemic dysfunction, preconditioning, stunning, hibernation, necrosis, and apoptosis. It then discusses the history and development of cardioplegic protection for the heart during cardiac surgery, including early methods using hypothermia, potassium-based solutions, and the introduction of the St. Thomas' Hospital Cardioplegia solution. The principles of cardioplegic protection are outlined, including inducing cardiac arrest, hypothermia, anti-ischemic agents, reperfusion, and protection of vascular and conduction tissues. Methods of inducing cardiac arrest through depolarized and polarized states are also summarized.
Vericiguat is a novel oral soluble guanylate cyclase stimulator being studied for the treatment of heart failure. The VICTORIA trial investigated vericiguat for reducing cardiovascular death or heart failure hospitalization in patients with recent worsening of chronic heart failure. The trial found that vericiguat reduced the primary composite outcome compared to placebo with an absolute risk reduction of 4.2 events per 100 patient-years. Vericiguat was well-tolerated overall but increased risks of hypotension and syncope compared to placebo. The results suggest vericiguat may be an effective additional treatment for reducing heart failure hospitalizations and cardiovascular death in patients with recent heart failure decompensation.
This document discusses the use of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for assessing coronary artery disease and optimizing percutaneous coronary intervention (PCI). Some key points:
1) IVUS has better tissue penetration than OCT but lower resolution. OCT has much higher resolution which allows more accurate lumen measurement.
2) Both IVUS and OCT can help optimize stent implantation by informing lesion preparation, stent sizing and placement to minimize geographic miss and under expansion.
3) Post-PCI, a minimum stent area (MSA) below 5mm2 seen on IVUS/OCT is associated with higher risk of restenosis and stent thrombosis. Under expansion is still common.
The document discusses acute right ventricular (RV) failure, including:
1) The RV's main job is to maintain low right atrial pressure to optimize venous return to the heart. RV dysfunction can lead to reduced cardiac output.
2) Treatment for RV failure differs from left ventricular failure - RV failure may require fluid administration while left sided failure uses diuretics.
3) RV infarction is associated with worse outcomes than left ventricular infarction such as higher mortality, and requires a tailored treatment approach including fluid administration in some cases rather than diuretics. Early revascularization can help recovery.
This document discusses complications that can occur during percutaneous coronary intervention (PCI), specifically contrast-induced nephropathy and coronary perforation. It defines contrast-induced nephropathy as acute kidney injury occurring after administration of radiocontrast media. Coronary perforation is defined as extravasation of contrast or blood from the coronary artery during or after PCI. The document discusses risk factors, prevention, diagnosis and management of these complications.
This document discusses static and dynamic indices used for hemodynamic monitoring. Static indices like CVP and PAOP are poor predictors of fluid responsiveness. Only about 50% of critically ill patients are fluid responsive. Dynamic indices that measure the response of cardiac output to fluid challenges or changes in preload are better predictors. The passive leg raise test is a non-invasive dynamic index that can reliably assess fluid responsiveness. Dynamic monitoring allows for goal-directed fluid therapy to optimize cardiac preload while avoiding over-resuscitation.
1) Cardiorenal syndrome commonly occurs in patients with acute decompensated heart failure and is associated with poor outcomes. It involves a complex interaction between hemodynamic alterations and activation of neurohormonal systems that affects both the heart and kidneys.
2) There are five types of cardiorenal syndrome classified based on the inciting cardiac or renal event and the affected secondary organs. Type 1 is acute cardiorenal syndrome due to acute worsening of cardiac function leading to kidney injury.
3) Loop diuretics are the mainstay of treatment for congestion in heart failure but aggressive diuresis may worsen kidney function. Other therapies discussed include inotropic agents, vasopressin antagonists
Insights from the FIGARO-DKD and FIDELIO-DKD trials - Dr. GawadNephroTube - Dr.Gawad
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/kanEHVsStsI
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
- Join our facebook group: www.facebook.com/groups/NephroTube
- Like our facebook page: www.facebook.com/NephroTube
- Follow us on twitter: www.twitter.com/NephroTube
Management strategy in HF with ARNI - Recent updates Praveen Nagula
- The document discusses management strategies for heart failure with reduced ejection fraction (HFrEF), including recent updates.
- It summarizes key differences between Indian and Western HF patients, noting that Indians develop HF at a younger age and with lower ejection fractions. Prognosis is also worse for Indian patients compared to those in the West.
- Core therapies for HFrEF are discussed, including a paradigm shift with the approval of sacubitril-valsartan which has been shown to reduce cardiovascular death compared to ACE inhibitors or ARBs alone in clinical trials.
LVEDP-guided hydration reduces the risk of CI-AKI and major adverse events at 6 months compared to standard hydration. In a randomized controlled trial of 350 patients with chronic kidney disease undergoing cardiac catheterization, the incidence of CI-AKI was lower in those receiving LVEDP-guided intravenous fluids (8%) compared to standard hydration (23%). LVEDP-guided hydration also reduced the composite of death, myocardial infarction, or need for renal replacement therapy at 6 months. No safety issues were reported with LVEDP measurement or fluid administration in this trial.
1. The document discusses cardiorenal syndrome (CRS), where acute or chronic dysfunction of the heart or kidneys can cause dysfunction in the other organ.
2. CRS is classified into 5 types depending on the rapidity of onset and primary organ affected. Various biomarkers can help classify CRS along with clinical evaluation.
3. Management of CRS is challenging and includes diuretics, ACE inhibitors, ARBs, beta-blockers, and renal replacement therapy. However, many treatments require careful use in patients with kidney disease.
The major physiological effects of counterpulsation include:
A) increased coronary artery perfusion, increased preload, decreased after load, decreased myocardial oxygen consumption
EMBOLISM AND FILTERS USED IN CARDIOPULMONARY BYPASSGLORY MINI MOL. A
FILTERS USED IN CARDIOPULMONARY BYPASS
EMBOLISM
DEFINITION: obstruction of an artery, by a clot of blood or an air bubble.
This emboli is categorized to
Biological emboli
Foreign emboli
Gaseous emboli
There are current technologies to decrease this embolic event delivered to patient
Membrane oxygenators
FILTER
Blood surface coating
Bubble traps
Emboli detection system
Blood Filters
Depth filters
Consist of packed fibers of Dacron wool or
polyurethane foam .
No defined pore size
These filters have large wetted surface
areas to filter the blood by absorption , they are effective in
trapping gross bubbles.
Screen filters
composed of a woven
mesh of polyester fibers
defined pore sizes
From 20 -40 μm
(all of the arterial line filters used are the screen type)
Right ventricular infarction (RVI) is rare but can occur alongside inferior wall myocardial infarction. It carries a higher mortality risk than inferior MI alone. RVI results from occlusion of the right coronary artery, with clinical features including hypotension, clear lung fields, and elevated jugular venous pressure. Diagnosis involves ECG showing ST elevations in right-sided leads and echocardiogram demonstrating right ventricular dysfunction. Treatment aims to support right ventricular preload and restore atrioventricular synchrony using inotropic support when needed. Combined therapies including inhaled nitric oxide and IABP may benefit patients with cardiogenic shock.
CytoSorbents Corporation (OTCBB: CTSO) is a critical care-focused therapeutic device company using blood purification to treat life-threatening illnesses. Its purification technology is based on biocompatible, highly porous polymer beads that can actively remove toxic substances from blood and other bodily fluids by pore capture and adsorption. In March 2011, CytoSorb™, the Company's flagship product, achieved European regulatory approval as an extracorporeal cytokine filter, and can now be sold throughout the European Union (E.U.) under the CE Mark to be used in cases where cytokines are elevated.
CytoSorbents Investor Short Presentation Nov 2011CytoSorbents
CytoSorbents is a critical care device company that has developed CytoSorb, a cytokine filter designed to reduce cytokine storm in life-threatening illnesses like sepsis. A clinical trial showed CytoSorb treatment significantly reduced cytokines like IL-6 in critically ill septic shock patients with multiple organ failure and respiratory distress, and improved mortality rates in high-risk patients. CytoSorb received European CE Mark approval and can now be sold as an extracorporeal cytokine filter throughout the EU.
1) Prosthetic heart valve thrombosis can occur with both mechanical and biological valves and is influenced by surface factors, hemodynamic factors, and hypercoagulability.
2) Clinical presentation may include heart failure symptoms or embolic events, and imaging with TEE is the standard for evaluation.
3) Treatment depends on severity of symptoms and includes anticoagulation, fibrinolytic therapy, or emergency surgery for severe cases.
A ventricular assist device (VAD) is a mechanical pump that helps the ventricles pump blood through the body. VADs are used to treat heart failure and cardiogenic shock. They can partially or completely replace the function of a failing heart. VADs are designed to assist the right ventricle, left ventricle, or both ventricles. Common uses of VADs include bridging patients to transplant, bridging to recovery or decision, and destination therapy for patients who are not eligible for transplant. Complications of VAD therapy include bleeding, infection, thromboembolism, device malfunction, and right heart failure.
Left ventricular assist devices (LVADs) are mechanical pumps that are used to support heart function in patients with heart failure. There are several indications for LVAD support including bridging patients to cardiac transplantation, bridging to decision about transplantation eligibility, as destination (permanent) therapy for those ineligible for transplantation, and bridging to potential heart recovery. LVADs improve symptoms and survival in advanced heart failure patients and can allow some to recover enough to no longer require support or become eligible for transplantation. Newer continuous flow LVAD designs have improved outcomes compared to older pulsatile devices.
This document discusses various inotropic and vasoactive drugs used for hemodynamic support. It provides details on the mechanisms of action, indications, dosing and side effects of drugs like adrenaline, noradrenaline, dopamine, dobutamine, milrinone, levosimendan, phenylephrine, vasopressin, isoprenaline, nitroglycerine and sodium nitroprusside. The effects of these drugs on parameters like cardiac output, systemic vascular resistance, blood pressure, heart rate and preload/afterload are summarized. Constitution, typical dosing and infusion rates are also outlined. The document concludes with a table on the hemodynamic management plan for various conditions like hypovole
1) The document discusses the role of cardiac resynchronization therapy (CRT) in treating chronic heart failure based on results from clinical trials.
2) Landmark trials like CARE-HF, MADIT-CRT and REVERSE showed that CRT reduces mortality and hospitalization in patients with heart failure symptoms.
3) Later trials also found benefits of CRT in mildly symptomatic patients with reduced left ventricular function and wide QRS duration, including decreased heart failure events and increased left ventricular ejection fraction, though effects on quality of life and exercise capacity were less clear.
This document discusses cardioplegia and surgical ischemia. It provides an overview of ischemic injury including acute ischemic dysfunction, preconditioning, stunning, hibernation, necrosis, and apoptosis. It then discusses the history and development of cardioplegic protection for the heart during cardiac surgery, including early methods using hypothermia, potassium-based solutions, and the introduction of the St. Thomas' Hospital Cardioplegia solution. The principles of cardioplegic protection are outlined, including inducing cardiac arrest, hypothermia, anti-ischemic agents, reperfusion, and protection of vascular and conduction tissues. Methods of inducing cardiac arrest through depolarized and polarized states are also summarized.
Vericiguat is a novel oral soluble guanylate cyclase stimulator being studied for the treatment of heart failure. The VICTORIA trial investigated vericiguat for reducing cardiovascular death or heart failure hospitalization in patients with recent worsening of chronic heart failure. The trial found that vericiguat reduced the primary composite outcome compared to placebo with an absolute risk reduction of 4.2 events per 100 patient-years. Vericiguat was well-tolerated overall but increased risks of hypotension and syncope compared to placebo. The results suggest vericiguat may be an effective additional treatment for reducing heart failure hospitalizations and cardiovascular death in patients with recent heart failure decompensation.
This document discusses the use of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for assessing coronary artery disease and optimizing percutaneous coronary intervention (PCI). Some key points:
1) IVUS has better tissue penetration than OCT but lower resolution. OCT has much higher resolution which allows more accurate lumen measurement.
2) Both IVUS and OCT can help optimize stent implantation by informing lesion preparation, stent sizing and placement to minimize geographic miss and under expansion.
3) Post-PCI, a minimum stent area (MSA) below 5mm2 seen on IVUS/OCT is associated with higher risk of restenosis and stent thrombosis. Under expansion is still common.
The document discusses acute right ventricular (RV) failure, including:
1) The RV's main job is to maintain low right atrial pressure to optimize venous return to the heart. RV dysfunction can lead to reduced cardiac output.
2) Treatment for RV failure differs from left ventricular failure - RV failure may require fluid administration while left sided failure uses diuretics.
3) RV infarction is associated with worse outcomes than left ventricular infarction such as higher mortality, and requires a tailored treatment approach including fluid administration in some cases rather than diuretics. Early revascularization can help recovery.
This document discusses complications that can occur during percutaneous coronary intervention (PCI), specifically contrast-induced nephropathy and coronary perforation. It defines contrast-induced nephropathy as acute kidney injury occurring after administration of radiocontrast media. Coronary perforation is defined as extravasation of contrast or blood from the coronary artery during or after PCI. The document discusses risk factors, prevention, diagnosis and management of these complications.
This document discusses static and dynamic indices used for hemodynamic monitoring. Static indices like CVP and PAOP are poor predictors of fluid responsiveness. Only about 50% of critically ill patients are fluid responsive. Dynamic indices that measure the response of cardiac output to fluid challenges or changes in preload are better predictors. The passive leg raise test is a non-invasive dynamic index that can reliably assess fluid responsiveness. Dynamic monitoring allows for goal-directed fluid therapy to optimize cardiac preload while avoiding over-resuscitation.
1) Cardiorenal syndrome commonly occurs in patients with acute decompensated heart failure and is associated with poor outcomes. It involves a complex interaction between hemodynamic alterations and activation of neurohormonal systems that affects both the heart and kidneys.
2) There are five types of cardiorenal syndrome classified based on the inciting cardiac or renal event and the affected secondary organs. Type 1 is acute cardiorenal syndrome due to acute worsening of cardiac function leading to kidney injury.
3) Loop diuretics are the mainstay of treatment for congestion in heart failure but aggressive diuresis may worsen kidney function. Other therapies discussed include inotropic agents, vasopressin antagonists
Insights from the FIGARO-DKD and FIDELIO-DKD trials - Dr. GawadNephroTube - Dr.Gawad
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/kanEHVsStsI
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
- Join our facebook group: www.facebook.com/groups/NephroTube
- Like our facebook page: www.facebook.com/NephroTube
- Follow us on twitter: www.twitter.com/NephroTube
Management strategy in HF with ARNI - Recent updates Praveen Nagula
- The document discusses management strategies for heart failure with reduced ejection fraction (HFrEF), including recent updates.
- It summarizes key differences between Indian and Western HF patients, noting that Indians develop HF at a younger age and with lower ejection fractions. Prognosis is also worse for Indian patients compared to those in the West.
- Core therapies for HFrEF are discussed, including a paradigm shift with the approval of sacubitril-valsartan which has been shown to reduce cardiovascular death compared to ACE inhibitors or ARBs alone in clinical trials.
LVEDP-guided hydration reduces the risk of CI-AKI and major adverse events at 6 months compared to standard hydration. In a randomized controlled trial of 350 patients with chronic kidney disease undergoing cardiac catheterization, the incidence of CI-AKI was lower in those receiving LVEDP-guided intravenous fluids (8%) compared to standard hydration (23%). LVEDP-guided hydration also reduced the composite of death, myocardial infarction, or need for renal replacement therapy at 6 months. No safety issues were reported with LVEDP measurement or fluid administration in this trial.
1. The document discusses cardiorenal syndrome (CRS), where acute or chronic dysfunction of the heart or kidneys can cause dysfunction in the other organ.
2. CRS is classified into 5 types depending on the rapidity of onset and primary organ affected. Various biomarkers can help classify CRS along with clinical evaluation.
3. Management of CRS is challenging and includes diuretics, ACE inhibitors, ARBs, beta-blockers, and renal replacement therapy. However, many treatments require careful use in patients with kidney disease.
The major physiological effects of counterpulsation include:
A) increased coronary artery perfusion, increased preload, decreased after load, decreased myocardial oxygen consumption
EMBOLISM AND FILTERS USED IN CARDIOPULMONARY BYPASSGLORY MINI MOL. A
FILTERS USED IN CARDIOPULMONARY BYPASS
EMBOLISM
DEFINITION: obstruction of an artery, by a clot of blood or an air bubble.
This emboli is categorized to
Biological emboli
Foreign emboli
Gaseous emboli
There are current technologies to decrease this embolic event delivered to patient
Membrane oxygenators
FILTER
Blood surface coating
Bubble traps
Emboli detection system
Blood Filters
Depth filters
Consist of packed fibers of Dacron wool or
polyurethane foam .
No defined pore size
These filters have large wetted surface
areas to filter the blood by absorption , they are effective in
trapping gross bubbles.
Screen filters
composed of a woven
mesh of polyester fibers
defined pore sizes
From 20 -40 μm
(all of the arterial line filters used are the screen type)
Right ventricular infarction (RVI) is rare but can occur alongside inferior wall myocardial infarction. It carries a higher mortality risk than inferior MI alone. RVI results from occlusion of the right coronary artery, with clinical features including hypotension, clear lung fields, and elevated jugular venous pressure. Diagnosis involves ECG showing ST elevations in right-sided leads and echocardiogram demonstrating right ventricular dysfunction. Treatment aims to support right ventricular preload and restore atrioventricular synchrony using inotropic support when needed. Combined therapies including inhaled nitric oxide and IABP may benefit patients with cardiogenic shock.
CytoSorbents Corporation (OTCBB: CTSO) is a critical care-focused therapeutic device company using blood purification to treat life-threatening illnesses. Its purification technology is based on biocompatible, highly porous polymer beads that can actively remove toxic substances from blood and other bodily fluids by pore capture and adsorption. In March 2011, CytoSorb™, the Company's flagship product, achieved European regulatory approval as an extracorporeal cytokine filter, and can now be sold throughout the European Union (E.U.) under the CE Mark to be used in cases where cytokines are elevated.
CytoSorbents Investor Short Presentation Nov 2011CytoSorbents
CytoSorbents is a critical care device company that has developed CytoSorb, a cytokine filter designed to reduce cytokine storm in life-threatening illnesses like sepsis. A clinical trial showed CytoSorb treatment significantly reduced cytokines like IL-6 in critically ill septic shock patients with multiple organ failure and respiratory distress, and improved mortality rates in high-risk patients. CytoSorb received European CE Mark approval and can now be sold as an extracorporeal cytokine filter throughout the EU.
Ctxr presentation mid-size_02.22.2019_spring.finalScott Martin
This 3-page corporate presentation by Citius Pharmaceuticals provides an overview of their investment opportunity and pipeline. Their lead product Mino-Lok is in Phase 3 trials for treating central line-associated bloodstream infections (CLABSI) and has the potential to salvage infected central venous catheters rather than requiring removal. They have a Phase 2 product for hemorrhoids and a pre-clinical product for preventing breast implant infections. The presentation highlights the large market opportunities and management team's experience advancing 505(b)(2) products.
Investor cytori presentation public website 9 9 15_finalcytoriIR
Cytori Therapeutics is developing Cytori Cell Therapy, which uses a patient's own adipose-derived regenerative cells, for several indications including scleroderma. Scleroderma causes fibrosis and impaired hand function, which is a major cause of disability. Cytori has completed early clinical trials for scleroderma showing good safety and sustained improvements in hand function, pain, and quality of life. Cytori is currently enrolling patients in a Phase 3 pivotal trial in the US and plans to initiate a Phase 2/3 trial in Europe. Preclinical studies demonstrate Cytori Cell Therapy's pleiotropic mechanisms of action in reducing fibrosis.
The document is a corporate presentation from Citius Pharmaceuticals that discusses their pipeline and lead product Mino-Lok. Mino-Lok is an antibiotic lock therapy designed to salvage central lines infected with bloodstream infections rather than requiring removal and replacement. It contains minocycline, EDTA, and ethanol. Phase 2b trials showed Mino-Lok eradicated infections in all patients while the control arm that removed and replaced lines saw relapses. No complications occurred with Mino-Lok versus an 18% complication rate for removal. An ex-US pilot trial also showed promise for Mino-Lok. Citius aims to develop cost-effective products for underserved areas through a 505(
Cytori Therapeutics is developing adipose-derived regenerative cell therapies using a point-of-care device platform. The platform allows for autologous cell therapies to be prepared at the bedside from a patient's own fat tissue. Clinical trials show the cells are safe and may provide benefits in cardiac and soft tissue applications. Near-term value drivers include government contract milestones and cardiovascular trial data. The business model involves selling single-use consumables for each procedure at price points around $2,000-$12,000, depending on the indication.
This document summarizes a report on the global market for minimally invasive surgical devices from 2010 to 2015. Some key points:
- The market was valued at $24.8 billion in 2010 and is projected to reach $34.8 billion by 2015.
- Minimally invasive surgery reduces hospital stays, recovery time, risks of infection, and costs compared to open surgery. Recent data shows it reduces hospital-acquired infections by 39-80%.
- The report provides market sizes, trends, and profiles of major companies for six surgical areas including orthopedics, neurosurgery, and cardiology. It also lists common procedures using minimally invasive devices.
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2. CytoSorbents 2
Safe Harbor Statement
Statements in this presentation regarding CytoSorbents Corporation and its operating
subsidiary CytoSorbents, Inc that are not historical facts are forward-looking statements
and are subject to risks and uncertainties that could cause actual future events or
results to differ materially from such statements. Any such forward-looking statements
are made pursuant to the safe harbor provisions of the Private Securities Litigation
Reform Act of 1995. It is routine for our internal projections and expectations to change.
Although these expectations may change, we are under no obligation to inform you if
they do. Actual events or results may differ materially from those contained in the
projections or forward-looking statements. The following factors, among others, could
cause our actual results to differ materially from those described in a forward-looking
statement: our history of losses; potential fluctuations in our quarterly and annual
results; competition, inability to achieve regulatory approval for our device, technology
systems beyond our control and technology-related defects that could affect the
companies’ products or reputation; risks related to adverse business conditions; our
dependence on key employees; competition for qualified personnel; the possible
unavailability of financing as and if needed; and risks related to protecting our
intellectual property rights or potential infringement of the intellectual property rights of
third parties. This list is intended to identify only certain of the principal factors that
could cause actual results to differ from those discussed in the forward-looking
statements. Readers are referred to a discussion of important risk factors detailed in the
Company’s Form 10-K filed with the Securities and Exchange Commission on May 31,
2011 and other reports and documents filed from time to time by us, which are available
online at www.sec.gov.
3. CytoSorbents 3
CytoSorbents Overview
CytoSorbents is a publicly-traded critical care-focused
device company using blood purification to treat disease,
with its first European Union approved product, CytoSorb™
4. CytoSorbents 4
• CytoSorb™ is now approved for use in the European Union as a first-in-
class cytokine filter, clinically proven to reduce “cytokine storm” in patients
with septic shock, one of the biggest killers in the intensive care unit
Recent Company Highlights
5. CytoSorbents 5
• CytoSorb™ is now approved for use in the European Union as a first-in-
class cytokine filter, clinically proven to reduce “cytokine storm” in patients
with septic shock, one of the biggest killers in the intensive care unit
• This reduction in “cytokine storm” led to a statistically significant
improvement in mortality in patients at highest risk of death from sepsis, in
a subgroup, post-hoc analysis
Recent Company Highlights
6. CytoSorbents 6
• CytoSorb™ is now approved for use in the European Union as a first-in-
class cytokine filter, clinically proven to reduce “cytokine storm” in patients
with septic shock, one of the biggest killers in the intensive care unit
• This reduction in “cytokine storm” led to a statistically significant
improvement in mortality in patients at highest risk of death from sepsis, in
a subgroup, post-hoc analysis
• We have now recorded our first ever initial revenue, albeit modest, with
sales to hospitals in Germany in a limited market release begun in
September. A formal market launch in Germany is planned for Q2 2012
Recent Company Highlights
7. CytoSorbents 7
• CytoSorb™ is now approved for use in the European Union as a first-in-
class cytokine filter, clinically proven to reduce “cytokine storm” in patients
with septic shock, one of the biggest killers in the intensive care unit
• This reduction in “cytokine storm” led to a statistically significant
improvement in mortality in patients at highest risk of death from sepsis, in
a subgroup, post-hoc analysis
• We have now recorded our first ever initial revenue, albeit modest, with
sales to hospitals in Germany in a limited market release begun in
September. A formal market launch in Germany is planned for Q2 2012
• The US Army is funding a Phase I SBIR grant to evaluate the use of
CytoSorb™ and our next generation technologies to treat trauma
Recent Company Highlights
8. CytoSorbents 8
• CytoSorb™ is now approved for use in the European Union as a first-in-
class cytokine filter, clinically proven to reduce “cytokine storm” in patients
with septic shock, one of the biggest killers in the intensive care unit
• This reduction in “cytokine storm” led to a statistically significant
improvement in mortality in patients at highest risk of death from sepsis, in
a subgroup, post-hoc analysis
• We have now recorded our first ever initial revenue, albeit modest, with
sales to hospitals in Germany in a limited market release begun in
September. A formal market launch in Germany is planned for Q2 2012
• The US Army is funding a Phase I SBIR grant to evaluate the use of
CytoSorb™ and our next generation technologies to treat trauma
• DARPA recently informed us that our cytokine and toxin binding
technology has been selected for funding in its “Dialysis-like Therapies”
initiative to treat sepsis, pending successful contract negotiations
Recent Company Highlights
9. CytoSorbents 9
Technology Overview
The heart of the technology is a
biocompatible, highly porous, polymer bead
that can remove a wide range of toxic substances
from blood and fluids based on
pore capture and surface adsorption
11. CytoSorbents 11
CytoSorb™
Is Our Flagship Product
CytoSorb™
is the cornerstone of our critical care strategy
that is now approved for sale in the European Union
as an Extracorporeal Cytokine Filter
to be used whenever cytokines are elevated
12. CytoSorbents 12
• Obtain venous access with temporary dialysis catheter
• Pump blood through the cartridge using standard
dialysis machines found in most hospitals
• The polymer beads remove cytokines
• “Purified” blood is pumped back into the patient
• Can treat 20-30 total blood volumes per 6 hr treatment
• Each treatment uses a new cartridge
CytoSorb™
is Elegant and Easy to Use
13. CytoSorbents 13
Cytokines: A Dual-Edged Sword
• Cytokines are small proteins that, in moderation,
normally help stimulate and regulate the
immune system. They are required for proper
immune system function
• However, in mild to moderate excess, cytokines
can cause or exacerbate disease (e.g.
autoimmune diseases)
• $14 billion in worldwide sales of specific anti-
cytokine therapies such as Enbrel (Amgen),
Remicade (J&J) and Humira (Abbott)
have validated the anti-cytokine approach
• But in vast excess, often called “cytokine storm”, as seen in critical
care illnesses, broader, more powerful therapies are needed
15. CytoSorbents 15
Shock
Clotting
Cytokine Storm Leads to Organ Failure
Cytokine Storm
Inflammation, Organ Failure and Infection
Lung Injury Cell Death
Intestinal
Injury
Immune
Paralysis
16. CytoSorbents
Sepsis is a Worldwide Crisis
Sepsis is the result of an overzealous immune response
to infection driven by “cytokine storm”
• Top 10 killer afflicting 18 million people worldwide every year
• Incidence of sepsis doubled in the past 10 years and is increasing
• Severe sepsis kills 1 in every 3 despite the best medical treatment.
Septic shock kills 1 in every 2
• Kills more people in the U.S. than either heart attacks, strokes, or any
single type of cancer
• Now there are NO approved therapies to treat it, with the withdrawal
of Xigris (Lilly) from all markets following a failed post-marketing study
16
17. CytoSorbents 17
CytoSorb™
European Sepsis Trial
Completed a randomized, controlled clinical trial in 43 patients
with predominantly septic shock and respiratory failure
• Compared Standard of Care (SOC) therapy alone
versus SOC therapy plus CytoSorb™
treatment
• Patients had a very high risk of death
• All had multiple organ failure
• Roughly half were age ≥ 65 (13-fold risk of death)
• Roughly one third had very high cytokine levels
• Two goals of the trial
• Demonstrate safety of treatment
• Achieve statistical significance of primary endpoint of IL-6 reduction
18. CytoSorbents 18
CytoSorb
™
Treatment was Safe
• No serious device related adverse events in more 300 treatments
in septic patients in the trial, increasing the total number of safely
administered human CytoSorb
™
treatments to more than 650
• Treatment was well-tolerated by patients
First Do No Harm
19. CytoSorbents
Achieved statistically significant 30-50% reduction in key
cytokines across the 7-day treatment period. Others are pending
49.1%
reduction
p=0.01*
49.5%
reduction
p=0.002
36.5%
reduction
p=0.001
30.2%
reduction
p=0.002
CytoSorb™
Broadly Reduces Cytokines
Electronic Randomization Only: N = 43 (18 treatment; 25 control) *interim/final analysis 19
20. CytoSorbents
CytoSorb
™
Reduces Mortality in
Patients with High Cytokines Levels*
CytoSorb™ treatment shows statistically significant reduction in
28-day mortality (0% vs 63% control, p=0.03, n=14)
• Also, treatment showed a trend to benefit in the reduced need for
mechanical ventilation at 28-days (33% vs 87% control, p=0.09, n = 14)
20* IL-6 (>1,000 pg/mL) or IL-1ra (>16,000 pg/mL)
21. CytoSorbents
CytoSorb
™
Reduces 14-day Mortality in
Patients Age ≥ 65
CytoSorb™ treatment for 7 days shows statistically significant
reduction in 14-day mortality (0.0% vs 36% control, p=0.04, n=21)
• To achieve mortality benefit at 28-days in this very sick population, we
are investigating more aggressive treatment
21
22. CytoSorbents
• Initial focus is on direct sales in Germany
* Sepsis * Acute Respiratory Distress Syndrome
* Trauma * Burn and smoke inhalation injury
* Pancreatitis * Surgical complications
• Initial orders from early adopters has begun with
early modest revenue for 2011 as part of a
controlled market release of CytoSorb™ in select
areas in Germany. Plan a broader launch in Germany in Q2 2012
• Manufacturing under ISO 13485 certification is in full swing
• The reimbursement path for CytoSorb™ has been established in Germany
• Plan to use partners or independent distributors to expand in Europe
• Will eventually target a US trial to seek FDA approval
22
CytoSorb™
Has Achieved First Revenue
23. CytoSorbents
• We were awarded a Phase I SBIR grant from the US Army Medical
Research and Materiel Command to develop and evaluate CytoSorb™
and our next generation technologies as a treatment for trauma and
rhabdomyolysis
• $100,000 over 6 months with option for additional $50,000
• Designed to allow us to plan and optimize our technological approach for a
planned Phase II SBIR submission in 2012 valued at up to $1 million
• DARPA (Defense Advanced Research Projects Agency) selected our
research proposal for funding for its multi-million dollar, multi-year
“Dialysis-Like Therapeutics” program for the treatment of sepsis,
pending successful contract negotiations
• Our proposal targets the removal of cytokines and toxins from blood
• Until the contract is negotiated and signed, which may take several months,
there is no guarantee of funding
23
CytoSorb™
Gaining Support from Home
24. CytoSorbents 24
With strong development capabilities
CytoSorbents Has a Robust Pipeline
NAME INDICATION DESCRIPTION STATUS
CytoSorb™ Severe sepsis and septic shock
ARDS/ acute lung injury
Burn and smoke inhalation injury
Trauma
Severe acute pancreatitis
Complications of influenza
Autoimmune disease flares
Highly efficient cytokine filter that is
designed to treat cytokine storm and
inflammation
European CE Mark
approved as a cytokine
filter in cases where
cytokines are elevated
CytoSorb™ Cardiac Surgery
Protection of organ transplants
Highly efficient cytokine filter to reduce
cytokine-induced organ injury
Observational human
study completed
Human pilot study
completed
HemoDefend Purification of blood transfusion
products
“Beads in a Bag” purification technology Pre-clinical proof of
concept completed
BetaSorb™ Improvement of hemodialysis in
end-stage renal disease
Removal of mid-molecular weight toxins
that are inefficiently removed by standard
dialysis
Four human pilot studies
completed
CST 101/201 Drug overdose/ Chemotherapy
removal during high dose
regional chemotherapy
Efficient single pass removal of drugs and
certain chemotherapy agents from blood
Pre-clinical proof of
concept completed
CST 301 Trauma Removal of myoglobin from blood caused
by muscle breakdown and
rhabdomyolysis in trauma
Pre-clinical proof of
concept completed
25. CytoSorbents
HemoDefend Protection for Blood Transfusions
• 30M blood transfusions in US each year
• Hundreds of thousands of people develop
transfusion reactions due to contaminants
in blood products
• HemoDefend beads are designed to go into
the blood storage bag and remove these
contaminants continuously during storage
• Neutrally buoyant beads distribute evenly,
so no mixing is needed
• A macrofilter prevents bead escape
• No additional equipment is needed
25
HemoDefend is a technology platform not yet approved in the US or EU
27. CytoSorbents 27
CytoSorbents has an active business development program
seeking partners for its growth technology portfolio
CytoSorb™
HemoDefend Others
Potential partners include companies involved in:
• Dialysis and renal therapies
• Pharmaceuticals
• Critical care
• Advanced materials
• Blood transfusion and blood purification
Partnerships help validate the technology, provide
resources to further develop products, are a source of
non-dilutive funding, and are potential M&A candidates
CytoSorbents Seeks Strategic Alliances
28. CytoSorbents
CytoSorbents represents a major potential growth story
• CytoSorb™ targets some of the biggest unmet medical needs in medicine
today by addressing the root cause of why many patients die in the ICU
• The total addressable market in critical care exceeds $10 billion
• With approval of CytoSorb™, the company is transitioning for the first time
in its history from a development-stage company to a revenue-based
company with early revenue
• The company has a strong IP position with 29 issued patents
• The pipeline for products continues to expand with HemoDefend and
others, enabling the company to monetize its rich technology portfolio
while pursuing core applications on its own
28
CytoSorbents Seeks New Investors
29. CytoSorbents
Phillip P. Chan, MD, PhD
CEO and President
7 Deer Park Drive, Suite K
Monmouth Junction, NJ 08852
(732) 329-8885
pchan@cytosorbents.com
CytoSorbents Corporation
Working to Save Lives
Through
Blood Purification
OTCBB: CTSO
CytoSorbents Corporation