Extracorporeal Blood Purification with CytoSorb in Patients with Shock: A Secondary Analysis of Standalone Circuit Configuration Versus Integrated Use within Extracorporeal Membrane Oxygenation in 359 Critically Ill Patients

Abstract

Objectives: CytoSorb, an extracorporeal blood purification device composed of biocompatible, highly porous polymer beads, is being increasingly adopted in different critically ill settings to allow for both enhanced organ protection and control of inflammation derangement. This investigation aimed to evaluate the characteristics and performances of two different CytoSorb circuit configurations to inform clinical practice. Design: We performed a secondary analysis of the largest available cohort of critically ill patients undergoing hemoadsorption with CytoSorb. Setting: Cardiac intensive care unit of a tertiary referral center university-hospital. Participants: Critically ill patients receiving CytoSorb. Interventions: CytoSorb as a standalone circuit was compared to the CytoSorb cartridge integrated within the extracorporeal membrane oxygenation (ECMO) circuit. Measurement and Main Results: Among the 359 patients included in the study, 148 (41%) received CytoSorb treatment with a standalone circuit and 211 (59%) had the CytoSorb cartridge integrated into the ECMO circuit. The reasons for ICU admission differed between the two groups, with patients in the ECMO group exhibiting higher inotropic load at baseline. Renal replacement therapy was administered in up to 34% of the overall population, with significantly greater use among those receiving ECMO support (p &lt; 0.001). Across both groups, patients received a median of two CytoSorb cartridges within a single cycle, and the duration of each cartridge and CytoSorb efficacy, assessed by reduction in inotropic load and improvement in laboratory exams, were comparable in both groups. Both ICU and hospital survival were higher in patients treated with CytoSorb as a standalone circuit (54.1% v 34.1%, p &lt; 0.001, and 49.3% v 30.8%, p &lt; 0.001, respectively). Conclusions: CytoSorb treatment proved safe and effective in both configurations. Despite substantial intergroup diversity at baseline and in their clinical outcomes, the choice of CytoSorb configuration had no impact on cartridge performance and duration.Objectives: CytoSorb, an extracorporeal blood purification device composed of biocompatible, highly porous polymer beads, is being increasingly adopted in different critically ill settings to allow for both enhanced organ protection and control of inflammation derangement. This investigation aimed to evaluate the characteristics and performances of two different CytoSorb circuit configurations to inform clinical practice. Design: We performed a secondary analysis of the largest available cohort of critically ill patients undergoing hemoadsorption with CytoSorb. Setting: Cardiac intensive care unit of a tertiary referral center university-hospital. Participants: Critically ill patients receiving CytoSorb. Interventions: CytoSorb as a standalone circuit was compared to the CytoSorb cartridge integrated within the extracorporeal membrane oxygenation (ECMO) circuit. Measurement and Main Results: Among the 359 patients included in the study, 148 (41%) received CytoSorb treatment with a standalone circuit and 211 (59%) had the CytoSorb cartridge integrated into the ECMO circuit. The reasons for ICU admission differed between the two groups, with patients in the ECMO group exhibiting higher inotropic load at baseline. Renal replacement therapy was administered in up to 34% of the overall population, with significantly greater use among those receiving ECMO support (p < 0.001). Across both groups, patients received a median of two CytoSorb cartridges within a single cycle, and the duration of each cartridge and CytoSorb efficacy, assessed by reduction in inotropic load and improvement in laboratory exams, were comparable in both groups. Both ICU and hospital survival were higher in patients treated with CytoSorb as a standalone circuit (54.1% v 34.1%, p < 0.001, and 49.3% v 30.8%, p < 0.001, respectively). Conclusions: CytoSorb treatment proved safe and effective in both configurations. Despite substantial intergroup diversity at baseline and in their clinical outcomes, the choice of CytoSorb configuration had no impact on cartridge performance and duration