FAQ Fields of Application

In which indications can CytoSorb be applied?

The use of CytoSorb is approved for all indications in which increased levels of cytokines occur (Intended Use). This is particularly the case in severe SIRS (Systemic inflammatory response syndrome)...

The use of CytoSorb is approved for all indications in which increased levels of cytokines occur (Intended Use).
This is particularly the case in severe SIRS (Systemic inflammatory response syndrome).

CytoSorb is frequently being used in two major indications:

  • Septic shock and severe sepsis
  • Severe SIRS in cardiac surgery patients

CytoSorb has also been used successfully in hyper-inflammatory conditions of other causes. A number of case reports on first clinical applications in some of the fields below have been published or presented:

  • Polytrauma and rhabdomyolysis
  • Serious burn injury
  • Severe acute pancreatitis
  • Various types of liver failure
  • Severe cardiogenic shock
  • Complications of cardiac surgery
  • Necrotizing fasciitis
  • Use with ECMO

When should CytoSorb therapy be started?

Previous clinical experiences and data suggest:

  • That treatment should begin in the early stage of severe sepsis or SIRS, when organ dysfunctions are still inflammation related and thus reversible...

Previous clinical experiences and data suggest:

  • That treatment should begin in the early stage of severe sepsis or SIRS, when organ dysfunctions are still inflammation related and thus reversible.
  • Use of CytoSorb is less promising if used when irreversible organ failure is present.

CytoSorbents provides a “best-practice” guideline (not evidence-based) for patient selection.
General principle: “It is better to avoid organ failure than to treat organ failure”

General indicators for CytoSorb Therapy can be (among others):

  • Patient is a non responder to standard medical treatment.
  • Clinical picture of hyper inflammation.
  • Onset of shock: Norepinephrine > 0,3µg/kg/min or rapidly increasing within the last 24 hrs.
  • Signs of capillary leak – e.g. positive fluid balance.
  • Development of at least one additional organ dysfunction:
    • Renal, respiratory, liver, coagulation, neurologic impairment.
  • High IL-6 level (e.g. >500 pg/ml) can support the treatment decision, but low levels do not preclude reasonableness of treatment.

In case of doubt, the clinical picture of the patient should be the most relevant criterion for the indication and efficacy assessment of CytoSorb therapy.

How do I know that a patient is responding positively to the CytoSorb therapy?

The evaluation of therapeutic success depends primarily on the clinical course. Signs of therapeutic success can be e.g.:

  • Stabilization of the haemodynamic situation: - Decreasing vasopressor need...

The evaluation of therapeutic success depends primarily on the clinical course.

Signs of therapeutic success can be e.g.:

  • Stabilization of the haemodynamic situation:
    – Decreasing vasopressor need (or slowdown of dosage increase).
    – Less positive fluid balance.
    – No further increase of lactate level.
  • Decrease of interleukin 6 level (if measured) and other inflammation/ infection parameters (WBC, PCT, CRP):
    – When assessing the course of PCT, be aware of direct PCT removal by CytoSorb.
    An increase of PCT during CytoSorb-therapy therefore must be evaluated critically.
  • Stabilization of other organ functions, e.g:
    – No further deterioration of liver function (synthesis and detoxification).
    – No further increase of ventilatory support necessary.
    – Improvement of coagulation situation.

When should CytoSorb therapy be stopped?

Duration of CytoSorb treatment depends on clinical improvement of the patient:

  • CytoSorb treatment should be continued until stabilization: - No need of catecholamines or rapidly decreasing dosage. - Reversal...

Duration of CytoSorb treatment depends on clinical improvement of the patient:

  • CytoSorb treatment should be continued until stabilization:
    – No need of catecholamines or rapidly decreasing dosage.
    – Reversal of fluid balance.
    – Normalization of lactate level.
  • Improvement of impaired organ functions:
    – Marked reduction of ventilatory support.
    – Return of spontaneous diuresis.
    – Improvement of liver function, e.g. increase of albumin level and decrease of alkaline phosphatase level.
  • Deterioration after cessation of CytoSorb treatment (insufficient focus control or second hit) may indicate necessity to recommence CytoSorb.
  • It must be decided individually for each patient, for how many days CytoSorb Therapy is continued.

Which patients should I select for the first CytoSorb treatments ?

  • CytoSorb should, at least during the first few treatments on patients, not be used as a last resort option.
  • The use of Cytosorb should be carefully considered for use in...

  • CytoSorb should, at least during the first few treatments on patients, not be used as a last resort option.
  • The use of Cytosorb should be carefully considered for use in patients who are already several days in therapy-refractory shock.