Cytokine hemoadsorption with CytoSorb® in post-cardiac arrest syndrome, a pilot randomized controlled trial

Critical Care

Research

Céline Monard¹  Marco Altarelli¹  Nathan Bianchi¹  Elettra Poli¹  Lucas Liaudet²  Antoine Schneider²  Mauro Oddo³  Anne Debonneville⁴ 

[1]Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

[2]Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

[3]Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland

[4]Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

[5]Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland

[6]Medical Directorate, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

[7]Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

[8]Thoracic Surgery Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

关键词: Cardiac arrest;    Cytokine hemoadsorption;    Extracorporeal blood purification;    Hemoperfusion;    Inflammation;    Post-cardiac arrest syndrome;   

DOI  :  10.1186/s13054-023-04323-x

 received in 2022-11-21, accepted in 2023-01-14,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundHemoadsorption (HA) might mitigate the systemic inflammatory response associated with post-cardiac arrest syndrome (PCAS) and improve outcomes. Here, we investigated the feasibility, safety and efficacy of HA with CytoSorb® in cardiac arrest (CA) survivors at risk of PCAS.MethodsIn this pilot randomized controlled trial, we included patients admitted to our intensive care unit following CA and likely to develop PCAS: required norepinephrine (> 0.2 µg/kg/min), and/or had serum lactate > 6 mmol/l and/or a time-to-return of spontaneous circulation (ROSC) > 25 min. Those requiring ECMO or renal replacement therapy were excluded. Eligible patients were randomly allocated to either receive standard of care (SOC) or SOC plus HA. Hemoadsorption was performed as stand-alone therapy for 24 h, using CytoSorb® and regional heparin–protamine anticoagulation. We collected feasibility, safety and clinical data as well as serial plasma cytokines levels within 72 h of randomization.ResultsWe enrolled 21 patients, of whom 16 (76%) had out-of-hospital CA. Median (IQR) time-to-ROSC was 30 (20, 45) minutes. Ten were assigned to the HA group and 11 to the SOC group. Hemoadsorption was initiated in all patients allocated to the HA group within 18 (11, 23) h of ICU admission and conducted for a median duration of 21 (14, 24) h. The intervention was well tolerated except for a trend for a higher rate of aPTT elevation (5 (50%) vs 2 (18%) p = 0.18) and mild (100–150 G/L) thrombocytopenia at day 1 (5 (50%) vs 2 (18%) p = 0.18). Interleukin (IL)-6 plasma levels at randomization were low (< 100 pg/mL) in 10 (48%) patients and elevated (> 1000 pg/mL) in 6 (29%). The median relative reduction in IL-6 at 48 h was 75% (60, 94) in the HA group versus 5% (− 47, 70) in the SOC group (p = 0.06).ConclusionsIn CA survivors at risk of PCAS, HA was feasible, safe and was associated with a nonsignificant reduction in cytokine plasma levels. Future trials are needed to further define the role of HA after CA. Those studies should include cytokine assessment to enrich the study population.Trial registration: NCT03523039, registered 14 May 2018.

【 授权许可】

CC BY   
© The Author(s) 2023

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