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Hemoadsorption efficacy for uncomplicated high-risk cardiac surgery

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The original article was published in Critical Care 2019 23:108

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].

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Abbreviations

CBP:

Cardiopulmonary bypass

IL-6:

Interleukin-6

IL-8:

Interleukin-8

SI:

Systemic inflammation

References

  1. 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. https://doi.org/10.1186/s13054-019-2399-4.

  2. 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. https://doi.org/10.5301/ijao.5000492.

  3. 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. https://doi.org/10.5301/ijao.5000583.

  4. 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. https://doi.org/10.1371/journal.pone.0187015.

  5. 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. https://doi.org/10.1186/s13613-019-0530-y.

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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.

Correspondence to Patrick M. Honore.

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Redant, S., Legrand, M., Langman, Y. et al. Hemoadsorption efficacy for uncomplicated high-risk cardiac surgery. Crit Care 23, 343 (2019) doi:10.1186/s13054-019-2629-9

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