The Use of CytoSorb Therapy in Critically Ill COVID-19 Patients: Review of the Rationale and Current Clinical Experiences.

Juan Carlos Ruiz-Rodríguez,Efthymios N Deliargyris,Ricard Ferrer,Zsolt Molnar

doi:10.1155/2021/7769516

Abstract

The COVID-19 pandemic has led to the biggest global health crisis of our lifetime. There is accumulating evidence that a substantial number of critically ill COVID-19 patients exhibit a dysregulated host response manifesting as cytokine storm or cytokine release syndrome, which in turn contributes to the high observed rates of mortality. Just as in other hyperinflammatory conditions, extracorporeal cytokine removal may have potential beneficial effects in this subgroup of COVID-19 patients. The CytoSorb blood purification device is the most extensively investigated cytokine removal platform with considerable evidence suggesting that early intervention can provide rapid hemodynamic stabilization and improvement in vital organ functions. The purpose of this review is to provide an overview of the pathophysiological background of hyperinflammation in COVID-19 and to summarize the currently available evidence on the effects of hemoadsorption in these patients.

Highlights

Background e COVID19 pandemic has led to the biggest global health crisis of our lifetime, in intensive care units (ICUs) [1]. e disease has caused high infectivity and fatality and universal economic burden and heavy financial losses [2]
E COVID-19 pandemic has led to the biggest global health crisis of our lifetime. ere is accumulating evidence that a substantial number of critically ill COVID-19 patients exhibit a dysregulated host response manifesting as cytokine storm or cytokine release syndrome, which in turn contributes to the high observed rates of mortality
Just as in other hyperinflammatory conditions, extracorporeal cytokine removal may have potential beneficial effects in this subgroup of COVID-19 patients. e CytoSorb blood purification device is the most extensively investigated cytokine removal platform with considerable evidence suggesting that early intervention can provide rapid hemodynamic stabilization and improvement in vital organ functions. e purpose of this review is to provide an overview of the pathophysiological background of hyperinflammation in COVID-19 and to summarize the currently available evidence on the effects of hemoadsorption in these patients

Summary

Early Experiences

Following the dramatic increases in critically ill COVID-19 patients that have overwhelmed ICUs around the world, many experts began recognizing some important and distinct features of this novel clinical syndrome. In this complex pathophysiological setting involving multiple mediators and high grade of redundancy, overlap, and/or feedback mechanisms, the broad range of action of CytoSorb therapy that targets removal of a variety of inflammatory substances in addition to cytokines could be—at least theoretically—beneficial [51] Hypercoagulopathy represents another distinct clinical feature of COVID-19 and is likely to be triggered by vascular endothelial cell injury [52]. Is recently published case series by Alharthy retrospectively analyzed 50 COVID-19 patients with AKI requiring continuous renal replacement therapy (CRRT) treated with CytoSorb [31] Comorbidities in this population included septic shock, acute respiratory distress syndrome (ARDS), and CRS. Tocilizumab is not expected to be removed, given its large molecular weight of 148 kDa [64]

Discussion

Results

Conclusions

Conflicts of Interest