Effect of hemoadsorption during cardiopulmonary bypass surgery – a blinded, randomized, controlled pilot study using a novel adsorbent

Bernardi, Martin H.; Rinoesl, Harald; Dragosits, Klaus; Ristl, Robin; Hoffelner, Friedrich; Opfermann, Philipp; Lamm, Christian; Preißing, Falk; Wiedemann, Dominik; Hiesmayr, Michael; Spittler, Andreas

doi:10.1186/s13054-016-1270-0

Cited by 140 publications

(181 citation statements)

References 37 publications

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“…A recent blinded, randomized, controlled pilot study examining the potential benefits of the CytoSorb adsorber in patients undergoing cardiopulmonary bypass (CPB) surgery found only minimal differences between the treated patients and the control group [28]. However, these were patients with only low or moderately increased risk, and who had no signs of uncontrolled hyperinflammation, either intraoperatively or postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Hemoadsorption by CytoSorb in septic patients: a case series

et al. 2017

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BackgroundSeptic shock, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, is a highly lethal condition that causes substantial morbidity and mortality among critically ill patients. One of the hallmarks of sepsis is the excessive release of cytokines and other inflammatory mediators causing refractory hypotension, tissue damage, metabolic acidosis and ultimately multiple organ failure. In this context, cytokine reduction by hemoadsorption represents a new concept for blood purification, developed to attenuate the overwhelming systemic levels of pro-inflammatory and anti-inflammatory mediators released in the early phase of sepsis.MethodsIn the present case series, we evaluated the impact of a new hemoadsorption device (CytoSorb) used as adjunctive therapy, on hemodynamics and clinically relevant outcome parameters in 26 critically ill patients with septic shock and in need of renal replacement therapy.ResultsWe found that treatment of these patients with septic shock was associated with hemodynamic stabilization and a reduction in blood lactate levels. Actual mortality in the overall patient population was lower than mortality predicted by acute physiology and chronic health evaluation II (APACHE II). These effects seem to be more pronounced in patients in whom therapy started within 24 h of sepsis diagnosis, whereas a delay in the start of therapy was associated with a poor response to therapy in terms of reduction of catecholamine demand and survival. Moreover, from our patient population, medical patients seemed to benefit more than post-surgical patients in terms of survival. Treatment using the CytoSorb device was safe and well-tolerated with no device-related adverse events during or after the treatment sessions.ConclusionHemoadsorption using CytoSorb resulted in rapid hemodynamic stabilization and increased survival, particularly in patients in whom therapy was started early. Given the positive clinical experience of this case series, randomized controlled trials are urgently needed to define the potential benefits of this new treatment option.

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Section: Discussionmentioning

confidence: 99%

Hemoadsorption by CytoSorb in septic patients: a case series

et al. 2017

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“…Cytokine levels were measured prior to and following CytoSorb treatment of 37 patients undergoing elective cardiopulmonary bypass. There were no significant differences in cytokine removal, vasopressor dependence or 30-day mortality with hemoadsorption therapy [106]. A more recent randomized, controlled trial investigated clinical outcomes in 97 mechanically ventilated patients with sepsis who underwent hemoadsorption therapy for 6 h per day for 7 consecutive days [107].…”

Section: Literature Evidence For Cytokine Adsorption Therapymentioning

confidence: 97%

Clinical Utility of Extracorporeal Cytokine Hemoadsorption Therapy: A Literature Review

et al. 2018

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Cytokines play a critical role in coordinating and amplifying a host immune response to infection. The normal pattern of localized and systemic release of proinflammatory and anti-inflammatory cytokines varies on the basis of the disease process. A dysregulated cytokine response can lead to a hyper-inflammatory condition called a cytokine storm. This is believed to contribute to the pathophysiology of sepsis and septic shock, a condition carrying high morbidity and mortality in critically ill patients. Extracorporeal cytokine hemoadsorption is an emerging technology utilized in the treatment of dysregulated inflammatory states such as sepsis, although there is a paucity of clinical evidence supporting its outcomes benefits. We assess the peer-reviewed literature relating to cytokine hemoadsorption in the context of sepsis and suggest areas of future research incorporating this novel technology.

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“…The majority of cytokines, inflammatory mediators, some endogenous molecules (myoglobin, free hemoglobin, bilirubin, and bile acids), and some exogenous molecules (toxin, metals, and drugs) fall within this size spectrum. The molecules removal is concentration dependent .…”

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confidence: 99%

Blood Purification With CytoSorb in Critically Ill Patients: Single‐Center Preliminary Experience

et al. 2018

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The CytoSorb adsorber, a blood purification therapy, is able to remove molecules in the 5-60 kDa range which comprises the majority of inflammatory mediators and some endogenous molecules. We aimed to evaluate CytoSorb therapy on clinical outcomes in critically ill patients. A retrospective case series study, from February 2016 to May 2017, was performed in 40 patients with multiple organ failure who received CytoSorb treatment. There were 28 patients with cardiogenic shock, 2 with septic shock, 9 with acute respiratory distress syndrome, and 1 with liver failure. Nineteen patients (47%) underwent extracorporeal membrane oxygenation, 11 (27%) had an intra-aortic balloon pump, 9 (22%) were implanted with Impella, 6 (15%) had a ventricular assist device, and 18 (45%) were treated with continuous veno-venous hemofiltration. After CytoSorb treatment, total bilirubin decreased from 11.6 ± 9.2 to 6.8 ± 5.1 mg/dL (P = 0.005), lactate from 12.1 ± 8.7 to 2.9 ± 2.5 mmol/L (P < 0.001), CPK from 2416 (670-8615) to 281 (44-2769) U/L (P <0.001) and LDH from 1230 (860-3157) to 787 (536-1148) U/L (P <0.001). The vasoactive-inotropic score after 48 h of treatment was reduced to 10 points, P = 0.009. Thirty-day mortality was 55% and ICU mortality was 52.5% at expected ICU mortality of 80%. Our study shows that CytoSorb treatment is effective in reducing bilirubin, lactate, CPK and LDH, in critically ill patients mainly due to cardiogenic shock. There is a need for randomized controlled trials to conclude on the potential benefits blood purification with CytoSorb in critically ill patients.

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Effect of hemoadsorption during cardiopulmonary bypass surgery – a blinded, randomized, controlled pilot study using a novel adsorbent

Cited by 140 publications

References 37 publications

Hemoadsorption by CytoSorb in septic patients: a case series

Hemoadsorption by CytoSorb in septic patients: a case series

Clinical Utility of Extracorporeal Cytokine Hemoadsorption Therapy: A Literature Review

Blood Purification With CytoSorb in Critically Ill Patients: Single‐Center Preliminary Experience

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