Extracorporeal Blood Purification with CytoSorb in 359 Critically Ill Patients

Abstract

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.

A Contemporary Review of the Use of Extracorporeal CytoSorb® Hemoadsorption Therapy in Patients with Infective Endocarditis

“…However, the effect of CytoSorb® hemoadsorption on hyperinflammation remains controversial across different clinical studies. Some observational studies suggest that CytoSorb® may lower circulating cytokine concentrations and improve organ dysfunction and hemodynamics in critically ill patients with various hyperinflammatory conditions [34][35][36]. Similarly, a prospective, randomized single center study by Ingo et al showed that a significant short-term reduction in proinflammatory cytokine levels of Il-8 and TNFα at 6 h after CPB could be observed in patients receiving on-pump cardiac surgery and intraoperative CytoSorb® hemoadsorption [37].…”

A Contemporary Review of the Use of Extracorporeal CytoSorb® Hemoadsorption Therapy in Patients with Infective Endocarditis

“…However, the effect of CytoSorb ® hemoadsorption on hyperinflammation remains controversial across different clinical studies. Some observational studies suggest that CytoSorb ® may lower circulating cytokine concentrations, ameliorate organ dysfunction, and improve hemodynamics in critically ill patients with various hyperinflammatory conditions [34][35][36]. Similarly, a prospective, randomized single-center study by Garau et al showed that a significant short-term decrease in the proinflammatory cytokine levels of IL-8 and TNF-α at 6 h after CPB could be observed in patients undergoing on-pump cardiac surgery and intraoperative CytoSorb ® hemoadsorption [37].…”