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DOI: 10.1055/s-0038-1627841
Impact of Cytokine Removal during Cardiopulmonary Bypass with CytoSorb®
Publication History
Publication Date:
22 January 2018 (online)
Objectives: The surgical trauma and the use of the cardiopulmonary bypass (CPB) induce a systematic inflammatory response (SIRS) which is associated with increased morbidity and mortality. Therefore, strategies to reduce the inflammatory response have a potential benefit for cardiac surgical patients. The clinical benefit of reduced release of proinflammatory cytokines such as IL-6, Il-8 and TNF-a with the use of a cytokine adsorbing filter (Cytosorb) during CPB remains unclear. Therefore, this prospective, observational pilot study was conducted to determine the clinical impact of the use of a cytokine adsorbing filter during CPB.
Methods: In this prospective pilot study we randomly assigned patients scheduled for elective on-pump coronary bypass surgery either to the Control (n = 97) or to the Cytosorb group (n = 94) receiving Cytosorb therapy during CPB. Inflammatory response (Il-6; Il-8; TNF-a) and clinical flow-up (MACCE; kidney injury, length of ventilation, catecholamine support, and stay) were analyzed. (NCT02213939).
Results: Parameters of inflammatory response to CPB (83.0 ± 27.4 minute) were significantly reduced in the Cytosorb group. Cytosorb therapy leads to shorter catecholamine support (p = 0.015), ventilation (p < 0.001), and ICU stay (p = 0.05). Trends in clinical endpoints without significance were seen in a reduced infection rate (24% versus 33%; p = 0.194) and less wound healing complications (4% versus 11%) in the Cytosorb® compared with the Control group.
Conclusion: The use of Cytosorb® during cardiopulmonary bypass is not inferior to standard of care. The usage of the filter is feasible and save. Cytosorb® reduces cytokines and inflammatory response compared with CPB. Trends in improved clinical recovery and reduced incidences of infection is under further investigation.