The Potential Role of Extracorporeal Cytokine Removal in Hemodynamic Stabilization in Hyperinflammatory Shock

Hawchar, Fatime; Rao, Cristina; Akil, Ali; Mehta, Yatin; Rugg, Christopher; Scheier, Joerg; Adamson, Harriet; Deliargyris, Efthymios N.; Molnár, Zsolt

doi:10.3390/biomedicines9070768

Cited by 27 publications

(26 citation statements)

References 94 publications

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“…Two recent reviews [ 58 , 59 ] of CytoSorb have suggested that adsorption therapy using this device appears to be safe and effective, but larger RCTs are needed to expand our knowledge of the new indication and target population. Hawchar et al summarized 33 available studies from PubMed database and demonstrated that early hemadsorption therapy plays an important role in rapidly resolving hemodynamic instability in patients with refractory paralytic shock [ 61 ], while another updated retrospective study showed that there was no advantage in alleviating cytokine storms or reducing mortality in critically ill patients with CytoSorb treatment compared to matched patients [ 62 ].…”

Section: Adsorptive Bptsmentioning

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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Section: Adsorptive Bptsmentioning

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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“…25 In this context, the CytoSorb hemoadsorber represents an approved therapeutic option with a proven safety profile, which has already shown its important contribution in achieving rapid hemodynamic stabilization in patients with refractory vasoplegic shock. 26 Further publications were also indicating promising effects as an adjuvant therapy option by managing the serious complications caused by hyperinflammation and vasoplegic shock in COVID-19 patients with severe ARDS. Data from eight COVID-19 patients with severe pneumonia requiring ECMO showed a more pronounced reduction of IL-6 in CytoSorb-treated patients, even though the initial IL-6 level was way higher when compared to the control group, 27 which was also the case in our patient cohort.…”

Section: Discussionmentioning

confidence: 99%

Blood purification therapy in patients with severe COVID-19 requiring veno-venous ECMO therapy: A retrospective study

Akil¹,

Ziegeler²,

Rehers³

et al. 2022

Int J Artif Organs

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Objective: Patients with severe manifestations of COVID-19 might exhibit characteristics of a sepsis-like syndrome that can progress to multiple organ failure and ultimately death. Underlying mechanism have been explored and suggest a profound dysregulation of the immune system associated with hyperinflammation, hemodynamic instability and respiratory failure. Besides standard intensive care treatment, approaches modulating the dysregulated immune response, such as CytoSorb hemoadsorption, have been used. However, data of ECMO-dependent patients in comparison to a control cohort remain scarce. Methods: Included were 26 critically ill COVID-19 patients requiring high-flow veno-venous extracorporeal membrane oxygenation (high-flow VV ECMO) therapy due to severe acute respiratory distress syndrome (ARDS), of whom 16 were additionally treated with an extracorporeal hemoadsorption device, and compared to a control group of 10 patients. Assessed were levels of inflammatory markers, vasopressor requirements, oxygenation parameters, as well as clinically relevant outcome variables. Data were prospectively recorded and retrospectively analyzed. Results: Treatment with the applied multimodal therapy approach resulted in a stabilization in hemodynamics, a control of the hyperinflammatory response as evidenced by a significant reduction in inflammatory mediators, as well as a marked improvement in lung function. No device related adverse events were observed while treatment appeared safe and feasible. Conclusion: Treatment of a critically ill COVID-19 ARDS patients with combined VV ECMO support and hemoadsorption therapy led to a rapid and sustained hemodynamic stabilization, a control of the uncontrolled inflammatory response and an improvement in oxygenation. Given these signals pointing toward a patient-oriented benefit of extracorporeal hemoadsorption therapy in those patients, future controlled, randomized studies should focus on the investigation of the appropriate timing and dosing of this promising treatment modality.

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“…Furthermore, data suggest that CytoSorb© use in combination with V-V ECMO may result in reduced SOFA scores already 24 h after start of CytoSorb treatment [ 13 ]. The effects on mortality in published reports vary: several data demonstrate lower observed versus predicted mortality [ 21 , 22 , 23 , 24 ], while studies showing higher mortality in CytoSorb©-treated patients have also been published [ 20 ]. Here, we aimed to analyze all available data to assess the effect of CytoSorb© adjunct therapy in patients with severe ARDS receiving V-V ECMO support.…”

Section: Introductionmentioning

confidence: 99%

Use of CytoSorb© Hemoadsorption in Patients on Veno-Venous ECMO Support for Severe Acute Respiratory Distress Syndrome: A Systematic Review

Akil¹,

Napp

Rao

et al. 2022

JCM

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Acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality. Adjunct hemoadsorption is increasingly utilized to target underlying hyperinflammation derived from ARDS. This article aims to review available data on the use of CytoSorb© therapy in combination with V-V ECMO in severe ARDS, and to assess the effects on inflammatory, laboratory and clinical parameters, as well as on patient outcomes. A systematic literature review was conducted and reported in compliance with principles derived from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. When applicable, a before-and-after analysis for relevant biomarkers and clinical parameters was carried out. CytoSorb© use was associated with significant reductions in circulating levels of C-reactive protein and interleukin-6 (p = 0.039 and p = 0.049, respectively). Increases in PaO2/FiO2 reached significance as well (p = 0.028), while norepinephrine dosage reductions showed a non-significant trend (p = 0.067). Mortality rates in CytoSorb© patients tended to be lower than those of control groups of most included studies, which, however, were characterized by high heterogeneity and low power. In an exploratory analysis on 90-day mortality in COVID-19 patients supported with V-V ECMO, the therapy was associated with a significantly reduced risk of death. Based on the reviewed data, CytoSorb© therapy is able to reduce inflammation and potentially improves survival in ARDS patients treated with V-V ECMO. Early initiation of CytoSorb© in conjunction with ECMO might offer a new approach to enhance lung rest and promote recovery in patients with severe ARDS.

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The Potential Role of Extracorporeal Cytokine Removal in Hemodynamic Stabilization in Hyperinflammatory Shock

Cited by 27 publications

References 94 publications

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

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

Blood purification therapy in patients with severe COVID-19 requiring veno-venous ECMO therapy: A retrospective study

Use of CytoSorb© Hemoadsorption in Patients on Veno-Venous ECMO Support for Severe Acute Respiratory Distress Syndrome: A Systematic Review

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