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Peer-reviewedCC BY 4.0PLOS One

Activated charcoal filtration profoundly alters systemic noradrenaline concentrations during hepatic chemosaturation: A prospective cohort study

  • Jan Turra1
  • Dania Fischer2
  • Osman Öcal3
  • Oliver Biecker4
  • Philipp Mayer5
  • Philippe Grieshaber6
  • Folker Wenzel7
  • Matthias Karck
  • Marina Nikolic
  • Maik von der Forst
  • Markus Weigand
  • Hans-Ulrich Kauczor
4 more authors
  • Jessica Cecile Hassel
  • Christoph Lichtenstern
  • Maximilian Dietrich
  • Patrick Rehn
7 affiliations
  1. 1Department of Perfusion, Heidelberg University Hospital, Im Neuenheimer Feld, Heidelberg, Germany
  2. 2Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld, Heidelberg, Germany
  3. 3Department of Radiology, Heidelberg University Hospital, Im Neuenheimer Feld, Heidelberg, Germany
  4. 4Department of Pediatric Cardiac Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster, Germany
  5. 5Furtwangen University of Applied Sciences, Faculty II: Engineering and Technology, Robert-Gerwig-Platz 1, Furtwangen im Schwarzwald, Germany
  6. 6Department of Cardiac Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, Heidelberg, Germany
  7. 7Heidelberg University, Medical Faculty Heidelberg, Department of Dermatology and National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and University Hospital Heidelberg, Heidelberg, Germany
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Abstract

Background: Hepatic chemosaturation using extracorporeal circulation (ECC) is associated with severe hemodynamic instability. Activated charcoal filters are used to prevent systemic toxicity, but their effects on circulating catecholamines remain poorly understood. Methods: In this prospective, single-center observational study, systemic catecholamine concentrations were measured in 15 procedures undergoing hepatic chemosaturation. Blood samples were obtained at predefined time points: after induction of anesthesia (T0), during initiation of ECC (T1), immediately before (T2.1) and after charcoal filtration (T2.2) and after termination of ECC (T3). Results: Systemic noradrenaline concentrations changed significantly over time (p < 0.001). The measured noradrenaline concentration increased markedly during inferior vena cava occlusion and ECC. This was consistent with pronounced hemodynamic instability and a significant increase in the dose of noradrenaline administered (T1 and T2.1 vs. T0), followed by a near-complete reduction across the activated charcoal filter (median extraction rate 95.5%) with continued high NA administration (median 0.35 µg/kg/min). In contrast, adrenaline and dopamine concentrations remained stable and were neither administered nor significantly affected by filtration. After termination of ECC, a pronounced rebound increase in noradrenaline concentrations was observed. These biochemical changes were accompanied by metabolic acidosis and rising lactate levels. Conclusion: Activated charcoal filtration during hepatic chemosaturation selectively removes circulating noradrenaline and is a key contributor to perioperative hemodynamic instability. Awareness of this mechanism is essential for tailored vasopressor strategies and safer anesthetic management. Trial registration: DRKS, DRKS00034527. Registered 24 June 2024, https://drks.de/search/de/trial/DRKS00034527

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Cite

BibTeXRIS
BibTeX
@article{turra2026activated,
  title = {{Activated charcoal filtration profoundly alters systemic noradrenaline concentrations during hepatic chemosaturation: A prospective cohort study}},
  author = {Jan Turra and Dania Fischer and Osman Öcal and Oliver Biecker and Philipp Mayer and Philippe Grieshaber and Folker Wenzel and Matthias Karck and Marina Nikolic and Maik von der Forst and Markus Weigand and Hans-Ulrich Kauczor and Jessica Cecile Hassel and Christoph Lichtenstern and Maximilian Dietrich and Patrick Rehn},
  journal = {PLOS One},
  year = {2026},
  month = aug,
  doi = {10.1371/journal.pone.0350771},
  url = {https://doi.org/10.1371/journal.pone.0350771},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Activated charcoal filtration profoundly alters systemic noradrenaline concentrations during hepatic chemosaturation: A prospective cohort study
AU  - Jan Turra
AU  - Dania Fischer
AU  - Osman Öcal
AU  - Oliver Biecker
AU  - Philipp Mayer
AU  - Philippe Grieshaber
AU  - Folker Wenzel
AU  - Matthias Karck
AU  - Marina Nikolic
AU  - Maik von der Forst
AU  - Markus Weigand
AU  - Hans-Ulrich Kauczor
AU  - Jessica Cecile Hassel
AU  - Christoph Lichtenstern
AU  - Maximilian Dietrich
AU  - Patrick Rehn
PY  - 2026
DA  - 2026/08/31
JO  - PLOS One
DO  - 10.1371/journal.pone.0350771
UR  - https://doi.org/10.1371/journal.pone.0350771
AB  - Background: Hepatic chemosaturation using extracorporeal circulation (ECC) is associated with severe hemodynamic instability. Activated charcoal filters are used to prevent systemic toxicity, but their effects on circulating catecholamines remain poorly understood. Methods: In this prospective, single-center observational study, systemic catecholamine concentrations were measured in 15 procedures undergoing hepatic chemosaturation. Blood samples were obtained at predefined time points: after induction of anesthesia (T0), during initiation of ECC (T1), immediately before (T2.1) and after charcoal filtration (T2.2) and after termination of ECC (T3). Results: Systemic noradrenaline concentrations changed significantly over time (p < 0.001). The measured noradrenaline concentration increased markedly during inferior vena cava occlusion and ECC. This was consistent with pronounced hemodynamic instability and a significant increase in the dose of noradrenaline administered (T1 and T2.1 vs. T0), followed by a near-complete reduction across the activated charcoal filter (median extraction rate 95.5%) with continued high NA administration (median 0.35 µg/kg/min). In contrast, adrenaline and dopamine concentrations remained stable and were neither administered nor significantly affected by filtration. After termination of ECC, a pronounced rebound increase in noradrenaline concentrations was observed. These biochemical changes were accompanied by metabolic acidosis and rising lactate levels. Conclusion: Activated charcoal filtration during hepatic chemosaturation selectively removes circulating noradrenaline and is a key contributor to perioperative hemodynamic instability. Awareness of this mechanism is essential for tailored vasopressor strategies and safer anesthetic management. Trial registration: DRKS, DRKS00034527. Registered 24 June 2024, https://drks.de/search/de/trial/DRKS00034527
SN  - 1932-6203
ER  -