Introduction: Mechanical circulatory support is becoming a more common therapy for end-stage heart failure in intensive cardiac care unit, and currently there are several types of devices that can be used as bridge therapy to recovery phase or hearth transplantation. Extracorporeal membrane oxygenation (ECMO) replaces heart and lung function using extracorporeal blood flow and it can be used as mechanical support in cardio-circulatory or respiratory failure. (1) In a patient on ECMO support there is a strong activation of inflammatory response in a short period of time, usually due to shock before the initiation of support, but also, due to long, non-physiological blood flow through the piping, rotational pump and the oxygenator, where there is higher possibility of development of infection. In this phase patients are hemodynamically unstable, dependent on vasoactive support and substitution of intravenous fluids with a raise in inflammatory markers seen in laboratory results. Adsorbers for extracorporeal blood purification (CytosorbTM) can absorb molecules ranging from 5 to 55 kDa, which is the size where cytokines and some metabolites such as bilirubin, bile acids and ammonium can be absorbed, and it can be used to control inflammatory response which eventually can damage blood vessel walls and lead to target organs damage.

Case report: This case report will show a 38-year-old patient who was hospitalized in Department of Cardiac Intensive Care after deterioration of his primary condition (cardiomyopathy) with hemodynamic instability, which lead to placement of both left and right sided mechanical circulatory support with an adsorber. This led to a decrease of inflammatory markers with good clinical and microbiological response. Patients soon underwent heart transplantation without any major complications and fast recovery.

Conclusion: Use of adsorber via ECMO machine or dialysis machine is a very complex procedure which needs responsible approach to intervention and the only guarantee of success lays in a multidisciplinary approach.