Cytokine clearance with CytoSorb® during cardiac surgery: a pilot randomized controlled trial.

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Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_CFD5FB3EFA6A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Cytokine clearance with CytoSorb® during cardiac surgery: a pilot randomized controlled trial.
Journal
Critical care
Author(s)
Poli E.C., Alberio L., Bauer-Doerries A., Marcucci C., Roumy A., Kirsch M., De Stefano E., Liaudet L., Schneider A.G.
ISSN
1466-609X (Electronic)
ISSN-L
1364-8535
Publication state
Published
Issued date
03/04/2019
Peer-reviewed
Oui
Volume
23
Number
1
Pages
108
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Cardiopulmonary bypass (CPB) is often associated with degrees of complex inflammatory response mediated by various cytokines. This response can, in severe cases, lead to systemic hypotension and organ dysfunction. Cytokine removal might therefore improve outcomes of patients undergoing cardiac surgery. CytoSorb® (Cytosorbents, NJ, USA) is a recent device designed to remove cytokine from the blood using haemoadsorption (HA). This trial aims to evaluate the potential of CytoSorb® to decrease peri-operative cytokine levels in cardiac surgery.
We have conducted a single-centre pilot randomized controlled trial in 30 patients undergoing elective cardiac surgery and deemed at risk of complications. Patients were randomly allocated to either standard of care (n = 15) or CytoSorb® HA (n = 15) during cardiopulmonary bypass (CPB). Our primary outcome was the difference between the two groups in cytokines levels (IL-1a, IL-1b, IL-2, IL-4, IL-5, IL-6, IL-10, TNF-α, IFN-γ, MCP-1) measured at anaesthesia induction, at the end of CPB, as well as 6 and 24 h post-CPB initiation. In a consecutive subgroup of patients (10 in HA group, 11 in control group), we performed cross-adsorber as well as serial measurements of coagulation factors' activity (antithrombin, von Willebrand factor, factor II, V, VIII, IX, XI, and XII).
Both groups were similar in terms of baseline and peri-operative characteristics. CytoSorb® HA during CPB was not associated with an increased incidence of adverse event. The procedure did not result in significant coagulation factors' adsorption but only some signs of coagulation activation. However, the intervention was associated neither with a decrease in pro- or anti-inflammatory cytokine levels nor with any improvement in relevant clinical outcomes.
CytoSorb® HA during CPB was not associated with a decrease in pro- or anti-inflammatory cytokines nor with an improvement in relevant clinical outcomes. The procedure was feasible and safe. Further studies should evaluate the efficacy of CytoSorb® HA in other clinical contexts.
ClinicalTrials.gov NCT02775123 . Registered 17 May 2016.
Keywords
Cardio-pulmonary bypass, Coagulation factors, CytoSorb®, Cytokines, Haemoadsorption
Pubmed
Web of science
Open Access
Yes
Create date
09/04/2019 6:21
Last modification date
20/08/2019 15:50
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