Use of the CytoSorb adsorption device in MDMA intoxication: a first-in-man application and in vitro study

A 21-year-old man with severe MDMA (ecstasy) overdose and multi-organ failure—including neurological impairment, hyperpyrexia, rhabdomyolysis, kidney and liver failure, and bleeding—was treated with a CytoSorb adsorber device. His serum MDMA concentration fell from 540 to 140 ng/ml within the first 24 hours, and levels of interleukin 6 and myoglobin also decreased, followed by clinical improvement and full recovery. In vitro, the device removed MDMA to undetectable levels. The authors suggest early use of the adsorber may help manage severe MDMA intoxication, though they cannot prove the clinical improvement was directly due to MDMA removal or to effects on rhabdomyolysis, hyperinflammation, or liver failure.

Study at a glance

Abstract

Abstract 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.