CytoSorb purification in critically ill SARS-CoV-2 patients

Pieri, Marina; Fominskiy, Evgeny; Nardelli, Pasquale; Bonizzoni, Matteo Aldo; Scandroglio, Anna Mara

doi:10.1177/03913988211052572

Cited by 10 publications

(16 citation statements)

References 11 publications

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“…In summary, thirteen eligible studies [ 13 , 20 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 ] with sufficient data on the outcomes of interest were included ( Figure 2 ).…”

Section: Resultsmentioning

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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“…In summary, thirteen eligible studies [ 13 , 20 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 ] with sufficient data on the outcomes of interest were included ( Figure 2 ).…”

Section: Resultsmentioning

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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“…CytoSorb treatment was started according to clinical judgment by the attending physician in case of severe inflammatory status with systemic clinical compromise and hemodynamic derangement, as shown by need for inotropes and incoming extrapulmonary organ failure [20, 26, 27]. In line with these criteria, CytoSorb treatment was indicated in all patients with refractory CA under mechanical chest compression and treated with extracorporeal life support.…”

Section: Methodsmentioning

confidence: 99%

Extracorporeal Blood Purification with CytoSorb in 359 Critically Ill Patients

Pieri,

Bonizzoni,

Belletti

et al. 2023

Blood Purif

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Introduction: Critically ill patients with inflammatory dysregulation and organ disfunction may benefit from blood purification, although the use of this technique has not been described in large case series. We evaluated clinical outcomes and survival in high-risk intensive care unit (ICU) patients who underwent extracorporeal blood purification. Methods: 359 consecutive ICU patients treated with CytoSorb were included. Results: Main admission diagnoses were 120 (34%) refractory cardiac arrest under mechanical chest compression; 101 (28%) profound cardiogenic shock; 81 (23%) post-cardiotomy cardiogenic shock; and 37 (10%) respiratory failure. Fifteen patients (4%) were positive for SARS-CoV-2 infection. We observed 49% 30-day mortality, 57% ICU mortality, and 62% hospital mortality, all lower than the 71% mortality predicted by SAPS II and 68% predicted by SOFA score. Parameters of shock and organ failure, above all vasoactive inotropic score, reduced during CytoSorb treatment. Multivariable analysis identified SAPS II, lactate dehydrogenase, ICU stay duration, vasoactive inotropic score, lactates, intra-aortic counterpulsation on top of VA-ECMO, and total bilirubin as predictors of mortality. No CytoSorb-related complications occurred. Conclusion: CytoSorb treatment was effective in reducing laboratory parameters of shock and vasoactive inotropic score with possible survival implications in a large population of critically ill patients.

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“…However, its clearance of bilirubin varies widely among different studies, which might be related to the type of disease. [ 37–40 ] The Prometheus system removes toxins through the plasma circulation and dialysis circulation. Bilirubin is removed by Prometheus 02 (anion exchange resin) in plasma circulation, and this adsorption column also shows good DBIL adsorption and relatively weak IBIL adsorption capacity.…”

Section: Commercial Polymer Adsorbents For Clinical Usementioning

confidence: 99%

Bilirubin Removal by Polymeric Adsorbents for Hyperbilirubinemia Therapy

Wang

Wei

Zhao

et al. 2023

Macromolecular Bioscience

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Hyperbilirubinemia, presenting as jaundice, is a life‐threatening critical illness in newborn babies and acute severe hepatic failure patients. Over the past few decades, extracorporeal hemoadsorption by adsorbent therapy has been widely applied in the treatment of hyperbilirubinemia. The capability of hemoadsorption depends on the adsorbents. Most of the clinically used bilirubin adsorbents are made up of styrene/divinylbenzene copolymer and quaternary ammonium salt, which usually have poor biocompatibility and weak mechanical strength. To overcome the drawbacks of commercial polymer adsorbents, advanced synthetic and natural polymers with/without nanomaterials have been designed, and novel adsorbent fabrication technologies have also been developed. In this review, the adsorption mechanism of bilirubin adsorbents has been summarized, which is the basic criterion in adsorbent development. Furthermore, the preparation method, adsorption mechanism, relative merits and practicability of the emerging bilirubin adsorbents have been evaluated. Based on the existing studies, this work highlights the future direction of the efforts on how to design and develop bilirubin adsorbents with good overall clinical performance. Perhaps this study can change traditional perspectives and propose new strategies for bilirubin clearance from the aspects of pathogenic mechanisms, metabolic pathways, and material‐based innovation.

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CytoSorb purification in critically ill SARS-CoV-2 patients

Cited by 10 publications

References 11 publications

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

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

Extracorporeal Blood Purification with CytoSorb in 359 Critically Ill Patients

Bilirubin Removal by Polymeric Adsorbents for Hyperbilirubinemia Therapy

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