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.

中文翻译：

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CytoSorb 吸附装置在 MDMA 中毒中的应用：首次人体应用和体外研究


背景 3,4-亚甲二氧基甲基苯丙胺（MDMA，“摇头丸”）滥用很常见，过量服用可能会导致严重并最终致命的多器官衰竭。迄今为止，尚无 MDMA 中毒的病因治疗方法，从循环中去除 MDMA 可能是预防用药过量后不良反应的合理措施。我们在这里展示了首次人体经验和体外数据，支持吸附器装置在严重 MDMA 过量服用中的潜在作用。结果 我们对一名 21 岁男性应用了 CytoSorb 吸附器装置，该男性患有严重 MDMA 中毒和多器官衰竭，包括神经功能障碍、高热、横纹肌溶解、少尿性肾功能衰竭、肝功能衰竭以及伴有播散性胃肠道和肌内出血的凝血病。使用吸附器装置与前 24 小时内血清 MDMA 浓度从 540 ng/ml 下降至 140 ng/ml、白细胞介素 6 和肌红蛋白水平降低以及随后的临床改善相关。患者器官功能恢复、神经功能完全恢复后出院。当吸附器装置将 MDMA 浓度降低至不可检测的水平时，可以在体外证实吸附器装置对 MDMA 的有效消除。结论 我们在这里报告的首次人体经验和体外数据显示了 CytoSorb 吸附器装置去除 MDMA 的能力。早期整合 CytoSorb 的使用可能会加强对严重 MDMA 中毒的治疗，尽管我们无法证明临床改善是否与 MDMA 的消除直接相关，或者对横纹肌溶解、过度炎症或肝衰竭的有益作用。 我们的研究结果鼓励在前瞻性研究中进一步研究 CytoSorb 吸附器装置，并评估其在其他中毒中的用途。