Cytokine adsorption and ECMO in patients with COVID-19 – Author's reply

Supady, Alexander

doi:10.1016/s2213-2600(21)00274-5

Cited by 7 publications

(7 citation statements)

References 12 publications

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“…For almost four decades, the hypothesis that quantitative removal of inflammatory mediators improves survival in sepsis has resulted in negative trials [ 2 ]. Unexpectedly however, our data reflect the results of the first multicenter trial having assessed cytokine adsorption in sepsis [ 3 ] and, despite the pathophysiological differences, of a recent trial assessing cytokine adsorption in severe patients affected by coronavirus disease 2019 (COVID-19) on extracorporeal membrane oxygenation [ 4 ]. It evidenced not only no effect of cytokine adsorption on circulating IL-6 levels, but also strikingly suggested an increased mortality in the cytokine adsorption group.…”

supporting

confidence: 64%

Cytokine adsorption in severe, refractory septic shock

et al. 2021

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supporting

confidence: 64%

Cytokine adsorption in severe, refractory septic shock

et al. 2021

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“…The systematic search in online databases produced 1362 potential titles and abstracts from database and hand searches (Figure 1). Thirty reports were identified for review, and after exclusion of ongoing trials and inadequate reports (Table S2), we included 19 reports from 18 unique trials with a total of 866 patients 19–21,29–35,36–43 …”

Section: Resultsmentioning

confidence: 99%

“…Thirty reports were identified for review, and after exclusion of ongoing trials and inadequate reports (Table S2), we included 19 reports from 18 unique trials with a total of 866 patients. [19][20][21][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]…”

Section: Systematic Searchmentioning

confidence: 99%

Mortality and adverse events of hemoadsorption with CytoSorb® in critically ill patients: A systematic review and meta‐analysis of randomized controlled trials

Heymann

Schorer

Putzu

2022

Acta Anaesthesiol Scand

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Background: The effects and safety of extracorporeal hemoadsorption with CytoSorb ® in critically ill patients with inflammatory conditions are controversial.Methods: We performed a systematic review with meta-analysis and trial sequential analysis (TSA) of randomized-controlled trials to assess the mortality and safety of CytoSorb ® therapy in critically ill patients with inflammatory conditions. Electronic databases were searched up to April 2022. The primary outcome was mortality at longest follow-up and secondary outcomes included various adverse event (AE) outcomes. Conflict of interest and funding of each trial were assessed. We calculated relative risk (RR) and 95% confidence interval (CI).Results: Fourteen published (n = 764) and 4 unpublished (n = 111) trials were included. Eight trials were performed in medical ICU patients and 10 in complex cardiac surgery. Ten trials had significant industrial funding or an author conflict of interest. Hemoadsorption with CytoSorb ® was associated with higher mortality at latest follow-up (16 trials, n = 807, 120 of 402 [29.85%] patients in the CytoSorb ® group vs. 98 of 405 [24.20%] patients in the control group, RR = 1.24 [95% CI, 1.04-1.49], p = .02, [TSA-adjusted CI, 0.92-1.68]) and at 30-days or in-hospital (11 trials, n = 727; RR = 1.41 [95% CI, 1.06-1.88], p = .02, ). Only one trial reported the definition of adverse event, while detailed results were reported in 3 trials; the risk of adverse events was not higher with CytoSorb ® . Certainty of evidence ranged from low to very low. Conclusion:Low certainty of evidence showed that the use of CytoSorb ® might increase mortality in critically ill patients with inflammatory conditions. Adverse events were frequent but underreported and not systematically evaluated. Industrial funding and conflict of interest were common. Considerable uncertainty about the findings does not allow firm conclusions and suggests a need for high-quality randomized trials to clarify mortality and adverse events related to CytoSorb ® .Editorial Comment: Hemoadsorption with CytoSorb ® have been used in critically ill patients despite lack of high quality data from RCTs suggesting any patient-important benefits. The findings from this systematic review and meta-analysis suggests an

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“…In case of patient thromboembolism (e.g. pulmonary embolism or deep vein thrombosis), the aPTT target was 60–80 s. 24 …”

Section: Methodsmentioning

confidence: 99%

Extracorporeal membrane oxygenation during the first three waves of the coronavirus disease 2019 pandemic: A retrospective single‐center registry study

et al. 2022

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Background Despite increasing knowledge about the optimal treatment for patients with severe COVID‐19, data from different cohorts suggested that survival of patients treated with ECMO seemed to decline over the course of the pandemic. Methods In this non‐interventional retrospective single‐center registry study we analyzed all consecutive patients tested positive for SARS‐CoV‐2 infection and supported with VV ECMO in our center during the first three waves of the pandemic. From March 2020 through June 2021, 59 patients have been included. Results Overall 90‐day survival was 32%. Besides changes in drug treatment for COVID‐19 and a lower PaO 2 /FiO 2 ratio before ECMO initiation during the third wave, all other patient baseline characteristics were similar during the three waves. Survival rate was highest during the first wave and lowest during the third wave, yet this difference was not statistically significant. Conclusions VV ECMO has shown to be a feasible and safe support option for patients with severe respiratory failure due to COVID‐19. The results from this single‐center study confirm findings from other cohorts showing declining survival rates of patients treated with VV ECMO during the COVID‐19 pandemic, however, the specific reasons for this finding remain unclear.

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Cytokine adsorption and ECMO in patients with COVID-19 – Author's reply

Cited by 7 publications

References 12 publications

Cytokine adsorption in severe, refractory septic shock

Cytokine adsorption in severe, refractory septic shock

Mortality and adverse events of hemoadsorption with CytoSorb® in critically ill patients: A systematic review and meta‐analysis of randomized controlled trials

Extracorporeal membrane oxygenation during the first three waves of the coronavirus disease 2019 pandemic: A retrospective single‐center registry study

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