Hemoadsorption does not Have Influence on Hemolysis During Cardiopulmonary Bypass

Bernardi, Martin H.; Rinoesl, Harald; Ristl, Robin; Wiedemann, Dominik; Hiesmayr, Michael

doi:10.1097/mat.0000000000000897

Cited by 14 publications

(15 citation statements)

References 30 publications

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“…Next, we aimed to assess the utility of circulating microvesicles and apoptotic bodies as indicators of inflammation and hemolysis. In our previous studies [4,5], we found no effect on inflammation and hemolysis between patients treated with hemoadsorption compared to the control group, although a greater decrease in haptoglobin levels on postoperative day 1 was observed. Using correlation analysis, we did not detect significant correlations between MV subpopulations, haptoglobin, free hemoglobin, bilirubin, lactate dehydrogenase and C-reactive protein (Fig.…”

Section: Vesicle Counts Correlate With High-motility Group Box-1 Levelscontrasting

confidence: 49%

“…High mechanical stress, different blood flow and pressure conditions, surface activation and cardiotomy suctioning can lead to excessive hemolysis during the perioperative course [18]. In our previous study [5], no effect on hemolysis between patients treated with hemoadsorption compared to the control group was found. However, a greater decrease in haptoglobin levels and an increase in lactate dehydrogenase on POD 1 in the control group was observed, which may be an indicator for free hemoglobin adsorption in the intervention group.…”

Section: Discussionmentioning

confidence: 84%

“…4 Christian Doppler Laboratory for Innovative Therapy Approaches in Sepsis, Department for Biomedical Research, Danube University Krems, Krems, Austria. 5 Department of Anesthesia and Intensive Care Medicine, Landeskrankenhaus Feldkirch, Feldkirch, Austria. 6 Division of Cardiac Thoracic Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.…”

Section: Discussionmentioning

confidence: 99%

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Influence of hemoadsorption during cardiopulmonary bypass on blood vesicle count and function

et al. 2020

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Background Extracorporeal circulation during major cardiac surgery triggers a systemic inflammatory response affecting the clinical course and outcome. Recently, extracellular vesicle (EV) research has shed light onto a novel cellular communication network during inflammation. Hemoadsorption (HA) systems have shown divergent results in modulating the systemic inflammatory response during cardiopulmonary bypass (CPB) surgery. To date, the effect of HA on circulating microvesicles (MVs) in patients undergoing CPB surgery is unknown. Methods Count and function of MVs, as part of the extracellular vesicle fraction, were assessed in a subcohort of a single-center, blinded, controlled study investigating the effect of the CytoSorb device during CPB. A total of 18 patients undergoing elective CPB surgery with (n = 9) and without (n = 9) HA device were included in the study. MV phenotyping and counting was conducted via flow cytometry and procoagulatory potential was measured by tissue factor-dependent MV assays. Results Both study groups exhibited comparable counts and post-operative kinetics in MV subsets. Tissue factor-dependent procoagulatory potential was not detectable in plasma at any timepoint. Post-operative course and laboratory parameters showed no correlation with MV counts in patients undergoing CPB surgery. Conclusion Additional artificial surfaces to the CPB-circuit introduced by the use of the HA device showed no effect on circulating MV count and function in these patients. Larger studies are needed to assess and clarify the effect of HA on circulating vesicle counts and function. Trial registration ClinicalTrials.Gov Identifier: NCT01879176; registration date: June 17, 2013; https://clinicaltrials.gov/ct2/show/NCT01879176

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Section: Vesicle Counts Correlate With High-motility Group Box-1 Levelscontrasting

confidence: 49%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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Influence of hemoadsorption during cardiopulmonary bypass on blood vesicle count and function

et al. 2020

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“…There are one systematic review [ 67 ], one multicenter RCT [ 68 ], five single-center RCTs (one ongoing) [ 69 – 73 ], and three related published studies [ 74 – 76 ]. In the systematic review published in 2021, except two RCTs investigating the application of extracorporeal cytokine adsorption therapy as a therapeutic add-on treatment in sepsis or septic shock, the other five RCTs investigated the application of CytoSorb as a preventive measure in cardiac surgery from 2016 to 2019.…”

Section: Evidence For the Application Of Cytosorb During Cpb Surgerymentioning

confidence: 99%

Application of Adsorptive Blood Purification Techniques during Cardiopulmonary Bypass in Cardiac Surgery

Liu

Zhou

2022

Oxidative Medicine and Cellular Longevity

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By reason of surgical demand, the majority of cardiovascular procedures still depend on the use of cardiopulmonary bypass (CPB). Due to the nonphysiological state of CPB, it can cause complex and unpredictable inflammatory response, which may lead to significant morbidity and mortality. Unfortunately, the pharmacological and mechanical strategies that currently exist do not offer significant advantages in controlling inflammatory response and improving patient outcomes. The best strategy to reduce inflammation in CPB is still uncertain. In recent years, adsorptive blood purification techniques (BPTs) have emerged, among which CytoSorb is the latest representative device. Currently, the primary application area of adsorptive BPTs is in the control and treatment of systemic hyperinflammatory states, such as refractory septic shock patients. However, the evidences on efficacy and safety of adsorptive BPTs application during CPB surgery are still inconclusive, so we summarize the relevant evidences here and suggest future potential research areas.

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“…Interestingly, although Bernardi et al [20] did not find a difference in IL-1b, IL-6, IL-18, and TNF-α levels in their 37-patients pilot RCT, they reported significantly higher levels of the anti-inflammatory IL-10 48 h after post-CPB. Again, there was no difference in clinical outcomes.…”

Section: Removal Of Pro-inflammatory Mediators and Other Substancesmentioning

confidence: 77%

Cytosorb® haemoadsorption: a potential game changer for patients needing myocardial surgical revascularisation

Ling¹,

Umakumar²,

Moss³

et al. 2022

Vessel Plus

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Cytosorb, an extracorporeal blood purification system, utilises the principles of haemoadsorption to remove low molecular weight substances from the blood, including multiple cytokines such as interleukin (IL)-1b, IL-6, IL-8, and tumour necrosis factor-α, and anti-platelet drugs aiming to improve clinical outcomes. Given the prominent role of pro-inflammatory cytokines in various inflammatory states, Cytosorb has seen growing application as a therapeutic immunomodulator including surgery. This review focuses on the effects of the use of Cytosorb in patients undergoing coronary artery bypass grafting (CABG) and the indications of removal of cytokines and anti-platelet agents such as ticagrelor. The evidence supports the feasibility and safety profile of Cytosorb, with no device-related adverse events reported in all studies. Initial studies suggest significant potential for Cytosorb in urgent or emergency CABG surgery to remove anti-platelet medication with promising benefits on clinical outcomes including fewer blood product transfusions, decreased length of intensive care unit stay, and lower re-sternotomy rates. Furthermore, a cost saving analysis indicated that intraoperative removal of ticagrelor with Cytosorb would be cost effective in the setting of emergency cardiac surgery. However, the evidence remains inconclusive when Cytosorb is used in elective CABG surgery for cytokine removal. Definite high quality clinical trials for both indications for Cytosorb in CABG surgery are needed to clarify if there is a clinically significant benefit in clinical outcomes. There is substantial trial activity for the application of Cytosorb in higher risk cardiac surgery to establish the place of Cytosorb in future treatment pathways in cardiac surgery.

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Hemoadsorption does not Have Influence on Hemolysis During Cardiopulmonary Bypass

Cited by 14 publications

References 30 publications

Influence of hemoadsorption during cardiopulmonary bypass on blood vesicle count and function

Influence of hemoadsorption during cardiopulmonary bypass on blood vesicle count and function

Application of Adsorptive Blood Purification Techniques during Cardiopulmonary Bypass in Cardiac Surgery

Cytosorb® haemoadsorption: a potential game changer for patients needing myocardial surgical revascularisation

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