Skip to main content

Hemoadsorption efficacy for uncomplicated high-risk cardiac surgery

The Original Article was published on 03 April 2019

We enthusiastically read the paper by Poli et al. related to the use of CytoSorb® in high-risk cardiac surgery. While use of CytoSorb® showed no clinical or laboratory benefit, it was not associated with any complications either [1]. We noted the low level of interleukin-6 (IL-6) reported in this study (i.e., median values < 50 pg/ml and < 200 pg/ml during and after CBP). This observation may explain why there was no obvious benefit. In the paper by Träger et al., a series of 16 post-cardiac surgery patients with systemic inflammation (SI) characterized by a mixture of cardiogenic shock and distributive shock with acute kidney injury requiring continuous renal replacement therapy were enrolled. The authors observed patients prior to treatment with CytoSorb® to have baseline IL-6 and IL-8 levels between 500 and 10,000 pg/mL and 50 and 1000 pg/mL, respectively. Along with a decrease in the interleukin levels, hemodynamic parameters including cardiac index and mean arterial pressure improved and the need for catecholamine declined [2]. The same benefit was observed when CytoSorb® was used intraoperatively for patients with endocarditis. These patients had a high level of IL-6 and IL-8 prior to the intervention [3]. It is also reported that among septic patients with elevated IL-6 (> 1000 pg/mL) requiring continuous renal replacement therapy, cytokine clearance was more efficient when hemoperfusion and hemoadsorption were utilized [4]. Patients with a significant preoperative SI, such as in endocarditis or sepsis or with complicated surgery, are the most likely to benefit from CytoSorb® therapy. We agree with the authors that some cardiac surgery patients might benefit from hemoadsorption device, but we believe that the indication should be tested in patients with a high level of circulating cytokines—such as IL-6 [5].

Availability of data and materials

Not applicable.



Cardiopulmonary bypass






Systemic inflammation


  1. Poli EC, Alberio L, Bauer-Doerries A, Marcucci C, Roumy A, Kirsch M, et al. Cytokine clearance with CytoSorb® during cardiac surgery: a pilot randomized controlled trial. Crit Care. 2019;23(1):108.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Träger K, Fritzler D, Fischer G, Schröder J, Skrabal C, Liebold A, et al. Treatment of post-cardiopulmonary bypass SIRS by hemoadsorption: a case series. Int J Artif Organs. 2016;39(3):141–6.

    Article  CAS  PubMed  Google Scholar 

  3. Träger K, Skrabal C, Fischer G, Datzmann T, Schroeder J, Fritzler D, et al. Hemoadsorption treatment of patients with acute infective endocarditis during surgery with cardiopulmonary bypass - a case series. Int J Artif Organs. 2017;40(5):240–9.

    Article  PubMed  Google Scholar 

  4. Schädler D, Pausch C, Heise D, Meier-Hellmann A, Brederlau J, Weiler N, et al. The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: a randomized controlled trial. PLoS One. 2017;12(10):e0187015.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Honore PM, Hoste E, Molnar Z, Jacobs R, Joannes-Boyau O, Malbrain MLN, Forni L. Cytokine removal in human septic shock: where are we and where are we going? Ann of Intensive Care. 2019;9(1):56.

    Article  Google Scholar 

Download references





Author information

Authors and Affiliations



SR, KK, and PMH designed the paper. All authors participated in drafting and reviewing. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Patrick M. Honore.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This comment refers to the article available at

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Redant, S., Legrand, M., Langman, Y. et al. Hemoadsorption efficacy for uncomplicated high-risk cardiac surgery. Crit Care 23, 343 (2019).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: