Impact of intraoperative cytokine adsorption on outcome of patients undergoing orthotopic heart transplantation—an observational study

Németh, Endre; Kovács, Enikő; Rácz, Kristóf; Soltész, Ádám; Szigeti, Szabolcs; Kiss, Nikolett; Csikós, Gergely; Koritsanszky, Kinga B.; Berzsenyi, Viktor; Trembickij, Gabor; Fabry, Szabolcs; Prohászka, Zoltán; Merkely, Béla; Gál, János

doi:10.1111/ctr.13211

Cited by 64 publications

(60 citation statements)

References 37 publications

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“…Although the difference between the groups did not reach statistical significance, these results at least provide some physiological background that vasodilatation, most likely due to the overwhelming effects of pro-inflammatory cytokines, was better controlled in the treated group. This finding is in accordance with previously reported data, both in case series and in recent clinical studies [25]. It is also important to note, that the most profound effects were observed during the first 12 h of treatment, which has not been reported before.…”

Section: Clinical Effectssupporting

confidence: 94%

Extracorporeal cytokine adsorption in septic shock: A proof of concept randomized, controlled pilot study

Hawchar

László

Öveges

et al. 2019

Journal of Critical Care

153

164

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Background: The aim of this proof of concept, prospective, randomized pilot trial was to investigate the effects of extracorporeal cytokine removal (CytoSorb®) applied as a standalone treatment in patients with septic shock. Methods: 20 patients with early (b24 h) onset of septic shock of medical origin, on mechanical ventilation, norepinephrineN10 μg/min, procalcitonin (PCT) N 3 ng/mL without the need for renal replacement therapy were randomized into CytoSorb (n = 10) and Control groups (n = 10). CytoSorb therapy lasted for 24 h. Clinical and laboratory data were recorded at baseline (T 0), T 12 , T 24 , and T 48 hours. Results: Overall SOFA scores did not differ between the groups. In the CytoSorb-group norepinephrine requirements and PCT concentration decreased significantly

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Section: Clinical Effectssupporting

confidence: 94%

Extracorporeal cytokine adsorption in septic shock: A proof of concept randomized, controlled pilot study

Hawchar

László

Öveges

et al. 2019

Journal of Critical Care

153

164

View full text Add to dashboard Cite

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“…Similarly, a prospective randomized control trial in patients who underwent cardiac surgery also found no significant impact on cytokine concentrations although this study was not performed in sepsis [76]. In a recent propensity-matched retrospective study on 32 patients, the influence of intraoperative cytokine adsorption on the perioperative vasoplegia, inflammatory response and outcome during orthotopic heart transplantation was investigated [77]. Intraoperative CytoSorb treatment was associated with reduced vasopressor demand and less frequent RRT with no difference in length of mechanical ventilation and ICU stay [78].…”

Section: Does the Use Of Cytosorb Haemoadsorption Therapy In Patientsmentioning

confidence: 99%

Cytokine removal in human septic shock: Where are we and where are we going?

Honoré

Hoste

Molnár

et al. 2019

Ann. Intensive Care

146

119

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Although improving, the mortality from septic shock still remains high despite increased international awareness. As a consequence, much effort has focused on alternative treatment strategies in an effort to improve outcomes. The application of blood purification therapies to improve immune homeostasis has been suggested as one such method, but these approaches, such as high-volume continuous haemofiltration or cytokine and/or endotoxin removal, have enjoyed little success to date. More recently, the use of sorbent technologies has attracted much attention. These adsorbers are highly effective at removing inflammatory mediators, in particular, cytokines, from the bloodstream. This narrative review is the executive summary of meetings held throughout the 6th International Fluid Academy Days in Antwerp, Belgium (Nov 23–25, 2017), focusing on the current understanding regarding the use of such adsorbers in humans with septic shock. We followed a modified Delphi approach involving a combination of evidence appraisal together with expert opinion in order to achieve recommendations for practice and, importantly, future research.

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“…3]. Less vasopressor was needed during the operation, and fewer renal replacement therapy implemented after the surgery in patients who used Cytosorb connected to the cardiopulmonary by-pass [23,24]. In a study performed by Gleason et al, patients with haemoadsorption had a significantly lower free haemoglobin and activated complement serum concentrations [25].…”

Section: State Of Knowledgementioning

confidence: 99%

Applications of Cytosorb in clinical practice

Kutnik¹,

Borys²

2019

J Pre Clin Clin Res.

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Introduction and objective. Cytososorb is haemadsorption device approved in the European Union in 2011 for cytokine adsorption. Recently, in 2018, new indications for the device use have been added, including bilirubin and myoglobin removal. This study aimed to present the results of studies pertaining to Cytosorb use in clinical practice. In subsequent sections of this review, indications for Cytosorb therapy and clinical relevance of presented evidence are listed. State of knowledge. In clinical practice, Cytosorb has been reported as one of potential supportive therapies in patients with septic shock. There is evidence of significant reduction of interleukin 6 and vasopressors when Cytosorb is implemented. However, the decreased mortality after Cytosorb has yet to be reported. Besides cytokine adsorption, Cytosorb also collects drugs, a property that can have a beneficial effect on acute drug poisoning (anticoagulants). However, Cytosorb lowers the plasma concentration of some antibiotics which might affect the outcome of patients in septic shock. The haemadsorption device has also been researched in cardiac patients, and some reports suggest a reduced need for vasopressors and blood transfusions when therapy is installed during surgery. Other indications for Cytosorb are also reported, especially the effectiveness in decreasing bilirubin serum concentrations as treatment or bridge therapy, without affecting the albumins. Cytosorb might also be the last resort treatment in acquired haemophagocytic lymphohistiocytosis. Conclusions. The evidence supporting the use of CytoSorb remains elusive. There is lack of large prospective studies which could provide definitive answers about the place of Cytosorb in clinical practice. There are no reports of safety and feasibility issues in all presented studies.

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Impact of intraoperative cytokine adsorption on outcome of patients undergoing orthotopic heart transplantation—an observational study

Abstract: Intraoperative CA treatment was associated with reduced vasopressor demand and less frequent renal replacement therapy with a favorable tendency in length of mechanical ventilation and ICU stay. CA treatment was not linked to higher rates of adverse events.

Cited by 64 publications

References 37 publications

Extracorporeal cytokine adsorption in septic shock: A proof of concept randomized, controlled pilot study

Extracorporeal cytokine adsorption in septic shock: A proof of concept randomized, controlled pilot study

Cytokine removal in human septic shock: Where are we and where are we going?

Applications of Cytosorb in clinical practice

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