Comparison of the CytoSorb
            <sup>®</sup>
            300 mL and Jafron HA380 hemoadsorption devices: an
            <i>in vitro</i>
            study

Nierhaus, Axel; Morales, Jesus; Wendt, Daniel; Scheier, Jörg; Gutzler, Dominik; Jarczak, Dominik; Born, F.; Hagl, Christian; Deliargyris, Efthymios N.; Mehta, Yatin

doi:10.1080/13645706.2022.2104617

Cited by 24 publications

(16 citation statements)

References 18 publications

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“…To control the dysregulated immune homeostasis, blood purification techniques aim to eliminate the pro-inflammatory mediators from the circulation. One of these techniques, i.e., hemoadsorption with the CytoSorb column, adsorbs mid-molecular-weight solutes and binds them according to their intrinsic hydrophobic interactions, effectively removing them from the bloodstream [ 28 ]. As an adjuvant to renal replacement therapy for patients in septic shock, the use of the CytoSorb column is associated with decreased observed vs. expected mortality rates [ 29 , 30 ], improvement in hemodynamic stability [ 31 ] and shorter length of stay in the ICU [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Hemoadsorption (Cytosorb™) during Open Thoracoabdominal Aortic Repair: A Pilot Randomized Controlled Trial

Doukas

Hellfritsch

Wendt

et al. 2023

JCM

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Background: The efficacy of cytokine adsorption in controlling the early inflammation cascade after open thoracoabdominal aortic (TAAA) repair has not been investigated. The aim of this pilot randomized controlled trial was to assess the feasibility and effect of perioperative hemoadsorption during open TAAA repair. Methods: Patients scheduled for open TAAA repair with the use of cardiopulmonary bypass (CPB) were included. The patients were randomized the day before surgery to either intraoperative hemoadsorption during CPB or standard of care. Results: A total of 10 patients were randomly assigned to the intervention group, whereas the control group consisted of 17 patients (mean age of the total cohort, 51.1 ± 11.2 years, 67% male, 3 patients not randomized). The majority of baseline and perioperative characteristics were similar, and no device-related adverse events were reported. A trend to shorter ventilation times in the intervention group was observed (median 88 h vs. 510 h, p = 0.08, Δ422). Severe acute respiratory distress syndrome was significantly less in the intervention patients (p = 0.02). Conclusions: This is the first pilot study showing that the intraoperative use of hemoadsorption in open TAAA repair patients may be feasible and safe, yet larger trials are needed to evaluate whether intraoperative hemoadsorption is associated with improved clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Hemoadsorption (Cytosorb™) during Open Thoracoabdominal Aortic Repair: A Pilot Randomized Controlled Trial

Doukas

Hellfritsch

Wendt

et al. 2023

JCM

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“…The CytoSorb ® 300 mL device (CytoSorbents, Princeton, NJ, USA) is filled with highly biocompatible, porous polymer beads covered with a divinylbenzene coating. Each polymer bead is between 300 and 800 μm in size and has pores and channels, resulting in an effective surface area of more than 40,000 m 2 capable of binding hydrophobic small and medium-sized molecules [ 6 ]. Cytosorb ® is CE marked according to the Medical Devices Directive (ISO 10,993 biocompatible, manufactured in the United States under ISO 13,485 certification).…”

Section: Methodsmentioning

confidence: 99%

Removal of Apixaban during Emergency Cardiac Surgery Using Hemoadsorption with a Porous Polymer Bead Sorbent

Hassan

Thielmann

Easo³

et al. 2022

JCM

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Background: Patients on direct oral anticoagulants are at high risk of perioperative bleeding complications. We analyzed the results of intraoperative hemoadsorption (HA) in patients undergoing cardiac surgery who were also on concurrent therapy with apixaban. Methods: we included 25 consecutive patients on apixaban who underwent cardiac surgery with the use of cardio-pulmonary bypass (CPB) at three sites. The first 12 patients underwent surgery without hemoadsorption (controls), while the next 13 consecutive patients were operated with the Cytosorb® (Princeton, NJ, USA) device integrated into the CPB circuit (HA group). The primary outcome was perioperative bleeding assessed by the Bleeding Academic Research Consortium (BARC) definition and secondary outcomes included 24 h chest-tube-drainage (CTD) and need for 1-deamino-8-d-arginine-vasopressin (desmopressin (DDAVP)) administration to achieve hemostasis. Results: Preoperative mean daily dose of apixaban was higher in the HA group (8.5 ± 2.4 vs. 5.6 ± 2.2 mg, p = 0.005), while time since last apixaban dose was longer in the controls (1.3 ± 0.9 vs. 0.6 ± 1.2 days, p < 0.001). No BARC-4 bleeding events and no repeat-thoracotomies occurred in the HA group compared with 3 and 1, respectively, in the controls. Postoperative 24 h CTD volume was significantly lower in the HA group (510 ± 152 vs. 893 ± 579 mL, p = 0.03) and there was no need for DDAVP compared to controls, who received an average of 10 ± 13.6 mg (p = 0.01). Conclusions: In patients on apixaban undergoing emergent cardiac surgery, the intraoperative use of hemoadsorption was feasible and safe. Compared to patients operated on without hemoadsorption, BARC-4 bleeding complications did not occur and the need for 24 h CTD and DDAVP was significantly lower.

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“…3 ) [ 79 ]. Direct haemoadsorption is technically simple and efficient for cytokine removal [ 80 ]. An increasing body of evidence has justified further studies on direct haemoadsorption [ 79 , 81 ].…”

Section: Pathogenesis Of Sepsismentioning

confidence: 99%

Rationale for sequential extracorporeal therapy (SET) in sepsis

et al. 2023

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Sepsis and septic shock remain drivers for morbidity and mortality in critical illness. The clinical picture of patients presenting with these syndromes evolves rapidly and may be characterised by: (a) microbial host invasion, (b) establishment of an infection focus, (c) opsonisation of bacterial products (e.g. lipopolysaccharide), (d) recognition of pathogens resulting in an immune response, (e) cellular and humoral effects of circulating pathogen and pathogen products, (f) immunodysregulation and endocrine effects of cytokines, (g) endothelial and organ damage, and (h) organ crosstalk and multiple organ dysfunction. Each step may be a potential target for a specific therapeutic approach. At various stages, extracorporeal therapies may target circulating molecules for removal. In sequence, we could consider: (a) pathogen removal from the circulation with affinity binders and cartridges (specific), (b) circulating endotoxin removal by haemoperfusion with polymyxin B adsorbers (specific), (c) cytokine removal by haemoperfusion with sorbent cartridges or adsorbing membranes (non-specific), (d) extracorporeal organ support with different techniques for respiratory and cardiac support (CO2 removal or extracorporeal membrane oxygenation), and renal support (haemofiltration, haemodialysis, or ultrafiltration). The sequence of events and the use of different techniques at different points for specific targets will likely require trials with endpoints other than mortality. Instead, the primary objectives should be to achieve the desired action by using extracorporeal therapy at a specific point. Graphical Abstract

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Comparison of the CytoSorb ^® 300 mL and Jafron HA380 hemoadsorption devices: an in vitro study

Cited by 24 publications

References 18 publications

Intraoperative Hemoadsorption (Cytosorb™) during Open Thoracoabdominal Aortic Repair: A Pilot Randomized Controlled Trial

Intraoperative Hemoadsorption (Cytosorb™) during Open Thoracoabdominal Aortic Repair: A Pilot Randomized Controlled Trial

Removal of Apixaban during Emergency Cardiac Surgery Using Hemoadsorption with a Porous Polymer Bead Sorbent

Rationale for sequential extracorporeal therapy (SET) in sepsis

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Comparison of the CytoSorb ® 300 mL and Jafron HA380 hemoadsorption devices: an in vitro study

Cited by 24 publications

References 18 publications

Intraoperative Hemoadsorption (Cytosorb™) during Open Thoracoabdominal Aortic Repair: A Pilot Randomized Controlled Trial

Intraoperative Hemoadsorption (Cytosorb™) during Open Thoracoabdominal Aortic Repair: A Pilot Randomized Controlled Trial

Removal of Apixaban during Emergency Cardiac Surgery Using Hemoadsorption with a Porous Polymer Bead Sorbent

Rationale for sequential extracorporeal therapy (SET) in sepsis

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Product

Resources

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Comparison of the CytoSorb ^® 300 mL and Jafron HA380 hemoadsorption devices: an in vitro study