Hemoadsorption treatment with CytoSorb^® in patients with extracorporeal life support therapy: A case series

Abstract

Introduction: Extracorporeal life support is an increasingly used technique for respiratory and cardiocirculatory support. Besides primary organ dysfunction, an excessive systemic hyperinflammatory response can be the underlying cause for acute organ failure necessitating extracorporeal life support therapy, or it may be associated with the extracorporeal life support itself. Controlling this overwhelming inflammatory response using CytoSorb® hemoadsorption has been shown to be associated with improved hemodynamics and restored metabolic balance resulting in preserved organ functions. Methods: In this retrospective case series, we describe 23 patients undergoing extracorporeal life support therapy and CytoSorb hemoadsorption. Cytokine levels were monitored, hemodynamic and metabolic variables were recorded, and outcome measures such as duration of organ support, intensive care unit mortality, and hospital mortality were noted. Results: CytoSorb treatment was associated with a trend toward a reduction in plasma cytokine levels (first treatment median interleukin-6 pre 595 vs post 350 pg/mL (n.s.); second treatment median interleukin-6 317 vs 108 pg/mL, p < 0.05), a reduced vasoplegic response resulting in a reduction in vasopressor requirements (first treatment median norepinephrine pre 0.15 vs post 0.02 µg/kg/min (n.s.); second treatment median norepinephrine 0.1 vs 0.02 µg/kg/min, p < 0.05) as well as rebalancing of deranged metabolic parameters (first treatment median lactate pre-treatment 6 vs post-treatment median lactate 2 mmol/L, p < 0.05). The hemoperfusion treatment was well tolerated and safe, without the occurrence of any CytoSorb device-related adverse events. Conclusion: Hemoadsorption may offer a potentially promising therapeutic option for critically ill patients undergoing extracorporeal life support therapy, with cytokine reduction and a consecutively mitigated inflammatory response, decreased vasoplegia, and improved organ function as seen in our patients.

High-dose CytoSorb hemoadsorption is associated with improved survival in patients with septic shock: A retrospective cohort study

“…Among survivors, vasopressor use decreased to 31.6% after 72 hours and to 26.3% after 96 hours compared to baseline. In accordance with previous studies [28,29,32,40,44] a rapid shock reversal was achieved (Fig. 5).…”

“…CytoSorb® e ciently removes a broad spectrum of toxic PAMPs and DAMPs from the blood [26,27] invitro, which could alleviate the negative consequences, such as capillary leakage to improve microcirculation and organ function in-vivo [28,29].…”

High-dose CytoSorb hemoadsorption is associated with improved survival in patients with septic shock: A retrospective cohort study

“…after 96 hours compared to baseline. In accordance with previous studies [28,29,32,40,44] a rapid shock reversal was achieved (Fig. 5).…”

Can the cytokine adsorber CytoSorb® help to mitigate cytokine storm and reduce mortality in critically ill patients? A propensity score matching analysis

“…However, there are only limited prospective data with control groups available that investigate the elimination of cytokines using CS [21][22][23]. Although a decrease in cytokines was described by different authors [15,24], this could be due to causal therapy approaches such as anti-infective or supportive therapy [25].…”

“…Different authors showed a decrease in cytokines in patients treated with CS [14,15]; however, it remains unclear whether a comparable decrease would also have been observed without the use of CS, since control groups were missing. A randomized controlled trial recently published by Supady et al showed no difference in IL-6 reduction with and without CS in patients infected with Sars-CoV-2 and supported by extracorporeal membrane oxygenation [16].…”