Influence of Venoarterial Extracorporeal Membrane Oxygenation Integrated Hemoadsorption on the Early Reversal of Multiorgan and Microcirculatory Dysfunction and Outcome of Refractory Cardiogenic Shock

Abstract

Background: The purpose of this investigation was to evaluate the impact of venoarterial extracorporeal membrane oxygenation (VA–ECMO) integrated hemoadsorption on the reversal of multiorgan and microcirculatory dysfunction, and early mortality of refractory cardiogenic shock patients. Methods: Propensity score–matched cohort study of 29 pairs of patients. Subjects received either VA–ECMO supplemented with hemoadsorption or standard VA–ECMO management. Results: There was a lower mean sequential organ failure assessment score (p = 0.04), lactate concentration (p = 0.015), P(v–a)CO2 gap (p < 0.001), vasoactive inotropic score (p = 0.007), and reduced delta C–reactive protein level (p = 0.005) in the hemoadsorption compared to control groups after 72 h. In–hospital mortality was similar to the predictions in the control group (62.1%) and was much lower than the predicted value in the hemoadsorption group (44.8%). There were less ECMO-associated bleeding complications in the hemoadsorption group compared to controls (p = 0.049). Overall, 90-day survival was better in the hemoadsorption group than in controls without statistical significance. Conclusion: VA–ECMO integrated hemoadsorption treatment was associated with accelerated recovery of multiorgan and microcirculatory dysfunction, mitigated inflammatory response, less bleeding complications, and lower risk for early mortality in comparison with controls.

Does adjunctive hemoadsorption provide benefit in the management of ischemia–reperfusion syndrome following near-drowning? A case report

“…These fundings are in line with the observations described in this case report. Moreover, similar outcomes were reported in a propensity-score matched study of veno-arterial (va)ECMO patient population where adjunctive usage of CytoSorb was associated with accelerated recovery of multiorgan and microcirculatory dysfunction, mitigated inflammatory response, less bleeding complications, and lower risk for early mortality in comparison with controls ( 22 ).…”

Intraoperative Hemoadsorption (Cytosorb™) during Open Thoracoabdominal Aortic Repair: A Pilot Randomized Controlled Trial

“…One of these techniques, i.e., hemoadsorption with the CytoSorb column, adsorbs mid-molecular-weight solutes and binds them according to their intrinsic hydrophobic interactions, effectively removing them from the bloodstream [ 28 ]. As an adjuvant to renal replacement therapy for patients in septic shock, the use of the CytoSorb column is associated with decreased observed vs. expected mortality rates [ 29 , 30 ], improvement in hemodynamic stability [ 31 ] and shorter length of stay in the ICU [ 32 ]. Integrating the CytoSorb adsorber into the extracorporeal circulation assembly during cardiac surgery serves as the theoretical premise that cytokines induced through surgical trauma and the very application of cardiopulmonary bypass are eliminated at the time of their synthesis, thus promoting hemodynamic stability in the early postoperative phase, which was proven by the REMOVE trial [ 14 ].…”

The role of hemoadsorption in cardiac surgery – a systematic review

“…A recent study from Soltesz et al [ 69 ] evaluated the impact of vaECMO-integrated hemoadsorption on the reversal of multiorgan and microcirculatory dysfunction and early mortality of refractory cardiogenic shock patients. Among 29 vs. 29 propensity score-matched patients, CytoSorb ® treatment resulted in significantly lower VIS, lactate levels, and ECMO-associated bleeding complications.…”