Background ECMO support is associated with the development of a systemic hyper‐inflammatory response, which may become quite significant and extreme in some cases. We hypothesize that Cytosorb or Jafron therapy may benefit patients on V‐A ECMO in terms of levels of inflammatory markers such as IL‐6, complications, and overall outcomes. Methods We conducted a retrospective study of prospectively collected data in a single tertiary care center between January 2021 and April 2022. At the time of the analysis of this article, 20 patients on V‐A ECMO had cytokine adsorption while on ECMO support: Cytosorb group (n = 10), Jafron group (n = 10). In 10 ECMO‐supported patients cytokine adsorption was not used, this group served as a control group, which may be quite significant in some cases. Evaluation of the level of inflammatory markers (IL‐1, 6, 8; CRP, Leukocyte, Lactate, PCT, NT‐proBNP, TNF‐α) was performed. Results There was statistically significant longer CPB time, aortic cross‐clamp time and ICU stay in cytokine adsorption groups than in the control group, but there were no differences between subgroups with different types of haemoadsorption used. Moreover, in the control group mortality rate was higher than in the cytokine adsorption groups (60% vs. 20%, p = 0.02). All patients had an elevation of inflammatory markers in the perioperative and immediate postoperative periods. After 72 h of intensive care, blood inflammation markers had a tendency to decline. Conclusion At the time of writing, hemadsorption in patients requiring V‐A ECMO support represents a good therapeutic effect. This effect is permanent for the whole period of extracorporeal cytokine hemadsorption application for both CytoSorb and Jafron HA330 devices.

Background and Aims Cardiac surgery is maintained by various complications. Major contribution associated with cardiopulmonary bypass (CBP). Cardiac surgery with CPB provokes activation of the cascade mechanism of inflammation with releasing of cytokines and a systemic inflammatory response syndrome (SIRS). Activation of the contact system due to exposure of artificial surface of the bypass circuit to blood cells, endotoxemia, ischemia and reperfusion injury and surgical trauma are all potential triggers of inflammation following CPB. This inflammatory reaction may leads to the development of postoperative complications, including vasoplegia, cytokine storm, myocardial dysfunction, respiratory failure, acute kidney injury, coagulopathy bleeding, and multiple organ dysfunction syndrome (MODS).  A number of different strategies, including new pharmacologic agents, CPB circuits and components, and surgical techniques, have been employed during the last few years in attempts to minimize the impact of SIRS on the outcome of cardiac surgical patients. However, the complex pathophysiology of this problem has not allowed, until now, the use of a single strategy.  The aim of our study is assessment of early application of extracorporeal cytokine adsorbers to the inflammation system during open-heart surgery with prolonged cardiopulmonary bypass. Method This prospective randomized single-center controlled trial observed patients, who were assigned a planned open cardiac surgery with a duration of cardiopulmonary bypass (CPB) more than 120 minutes between January 2021 to January 2023. Patients were randomized into three groups: CytoSorb -300 group, HA 330 group and the control group. A simple 1:1:1 randomization method was applied. Cytokine hemadsorption was conducted intraoperatively. Two types of cytokine cartridges were applied CytoSorb 300 (Cytosorbents Europe GmbH). НА330 (Jafron Biomedical Co., Ltd. China). The inclusion criteria: age ≥18 years, informed consent to participate in the study, CPB more than 120 min. The exclusion criteria: Age less than 18 years; refusal to participate in the study. Results The data of the HA 330 (n = 22) and CytoSorb300 (n = 22) groups were compared with the data of the control group (n = 22). The primary results and details of the work are given in Tables 1-3. Conclusion Intraoperative hemadsorption may be beneficial for patients who underwent open-heart surgery with prolonged CPB. The early hemadsorption has positive impact to postoperative period after cardiac surgery and may reduce requirement of renal replacement therapy.

Background and Aims In the rapidly changing conditions of life due to the COVID - 19 pandemic, the medical society around the world have faced with the question of treatment previously unknown, multi-faceted and insidious infection. The coronavirus infection has forced doctors to reconsider the tactics of intensive care patients in critical condition. To date, overall mortality rate from COVID – 19 varied from 8.11 to 120.85 per 100.000 population (Johns Hopkins University mortality analyses). Mortality rate in extremely severe cases exceeds 60% - 78% (Yang et al., Lancet Respiratory Medicine, 2020. Zhou et al., Lancet, 2020). We would like to share our clinical experience of extracorporeal blood purification methods application to patients in ICU with various clinical manifestations, as well as the presence of comorbid pathology. Method We conducted a retrospective analysis of 239 medical records of patients hospitalized in the ICU of JSC NRCSC Nur-Sultan, Kazakhstan because of severe course of COVID 19. Period of hospitalization from 16.06.2020 to 29.09.2020, the total number of beds - 97, in the ICU - 25. Results The total number of patients with COVID -19 - 239 patients. In ICU -67 patients. Patients required in renal replacement therapy (RRT) – 31 patients. Among patients on RRT males-28 (90.3%) - female-3 (9.67%). Mean age-60 years. Distribution of the comorbid pathology. Indications for RRT: acute respiratory failure in the absence of heart failure or fluid overload; presence of diffuse alveolar damage (DAD) (detected by high-resolution CT); PaO2 / FiO2 ≤ 300 mm Hg Duration:> 6-24 hours per column with a blood flow rate of 80-120 ml/min. In addition, indications for the urgent start of extracorporeal treatment are: The duration of hospitalization in the ICU – 12.54 days. Combinations and duration of the procedures. Laboratory data - Leukocyte, CRP, Interleukine, procalcitonin, Creatinin, presepsin in dynamics. General Mortality – 37 from 239 (15.5%) Mortality in ICU – 37 from 67 (55.2%) According to literature review, the mortality rate of patients with severe COVID - 19 in the ICU (Fawad Rahim et al, Cureus . 2020 Oct 12;12(10):e10906. doi: 10.7759/cureus.10906.) without the use of CRRT exceeds 70-77%.) Conclusion Our analysis had showed a positive effect of early use (1 day of hospitalization) of extracorporeal methods of blood purification, on a decreasing of inflammation indicators, as well as positive survival rate of patients with severe COVID-19 course in ICU conditions.

BACKGROUND AND AIMS Complications after cardiac surgery have serious negative consequences, prolonging the average ICU stay days and costs. Prevention and treatment of complications after aortic valve replacement is a serious problem. According to numerous authors, the incidence of complications after aortic valve replacement varies from 10 to >60% of cases. Development of complications is associated with a higher hospital mortality rate, the risk of infection and a more complex course of the disease. Advances in cardiac surgery have led to a reduction in the overall mortality associated with open-heart surgery; however, it can still exceed 40% among those patients who develop a postoperative complication and can reach 50% in patients requiring extracorporeal blood purification therapy. Impaired renal function or active infectious process has significant prognostic consequences, which are the cause of up to 40% of deaths. The aim of this work is to structure or compare complications in immediate postoperative period after aortic valve replacement by the surgical and transcatheter method. METHOD Retrospective analysis of 267 medical records. All patients in study were after aortic valve replacement, hospitalized in JSC NSCC Nur-Sultan, Kazakhstan, from 1 January 2020 to 31 October 2021. A total of 127 patients SAVR, 137 patients TAVR. Of those, 3 patients were excluded from the study due to chronic haemodialysis. Inclusion criteria: informed consent to participate in research. Age is>18 years old. Prosthetics of the aortic valve by the SAVR or TAVR methods. Treatment of postoperative complications by the extracorporeal blood purification methods. Exclusion criteria: refusal to participate in research. Age is <18 years old. Chronic dialysis. Active bleeding. The patients were divided into two groups: group 1—patients after aortic valve replacement by the TAVR method and group 2—patients after open surgery aortic valve—SAVR. Indications for extracorporeal blood purification methods: acute kidney injury (AKI), acute liver injury, the systemic inflammatory response syndrome (SIRS) and cytokine storm. RESULTS Period from 2020 to 2021. TAVR group—137 patients, male―65 (47.45%), female—72 (52.55%), the average age of patients was 69.2±11.16 years. In the SAVR group, there were 127 patients, of which male 43 (33.9%) and female 84 (66.1%), the average age was 47.04 ± 13.67 years. CONCLUSION Complications and mortality rate are more common after open surgery SAVR than after TAVR. Extracorporeal blood purification methods are required after an open valve replacement. Extracorporeal blood purification methods are an effective way to treat complications such as AKI and SIRS after aortic valve replacement.

BACKGROUND AND AIMS Chronic heart failure (CHF) in the terminal stage is a crucial issue of medicine. Heart transplantation is still the best treatment option. Lack of donors, long waiting time make heart transplantation almost impossible. Implantation of left ventricular assist device—LVAD) in patients with CHF is a bridge to transplantation. Nevertheless, the LVAD implantation procedure is time-consuming, requires significant material costs, and leads to numerous complications in the postoperative period. Acute kidney injury (AKI) is one of the most common and dangerous complications. Issues of AKI in patients with LVAD should be carefully taught. The aim of the study is to examine the incidence of postoperative renal failure after the implantation of LVAD and its relationship to outcomes. In addition, we want to share with our experience of AKI management in patients with LVAD. METHOD A retrospective analysis of 265 medical records of patients after surgical implantation of LVAD who were hospitalized to the National Research Cardiac Surgery Center, Nur-Sultan city, Kazakhstan. Period of hospitalization from 01.2015 to 10.2021 year. The Kidney Disease Improving Global Outcome (KDIGO) criteria were used to define AKI. RESULTS Total number of patients 265 after LVAD implantation. Male—85.66% and female—14.34%. Mean ICU stay of patient without severe AKI—7.17±5.47 days. Mean ICU stay of patient with severe AKI—11.82±7.47 days. Patients with severe AKI and blood purification—59 patients (24.9%), male—61–92.4%, femal—-5–7.6%. Total number of LVAD patients—265. ICU Mortality rate of patients after LVAD implantation—11 patients (4.15%). Severe AKI—59 patients (22.3%). Recovery of AKI—47 patients (79.66%). Transformation to terminal stage of chronic renal disease (CRD) with chronic dialysis—1 patient (1.69%). ICU Mortality rate of patients with severe AKI—11 (18.64%). CONCLUSION AKI is a common complication in the immediate postoperative period after LVAD implantation. AKI negatively affects the outcome of the disease. The mortality rate of LVAD patients with renal insufficiency exceeds by 14% the mortality of patients with renal insufficiency. Blood purification is the effective method of severe AKI therapy.