Abstract
Severe rhabdomyolysis, characterized by extensive muscle breakdown and release of myoglobin and creatine kinase (CK), is a life-threatening condition often complicated by acute kidney injury (AKI) and multi-organ failure (MOF). Even when conventional treatments such as fluid resuscitation and renal replacement therapy (RRT) are timely applied, severe cases remain challenging to manage. Among therapies available in this setting, hemadsorption with CytoSorb has the potential not only to treat rhabdomyolysis through removal of circulating molecules but also to limit or even prevent rhabdomyolysis-related renal failure and MOF. In this case series we present a preliminary experience with a novel use CytoSorb hemoadsorption therapy, which encompassed the use of two CytoSorb cartridges running in parallel, to enhance myoglobin and cytokine clearance. Clinical data from the three patients with severe rhabdomyolysis treated with dual concomitant CytoSorb treatments highlighted marked improvements in CK, renal, hepatic, and inflammatory markers, with possible remarkable impact in containing rhabdomyolysis-related organ failure and death. Further investigation is warranted to establish the opportunity of tailored protocols for critically ill patients.