FAQ Management of Therapy

How is anticoagulation managed during CytoSorb therapy?

Treatment with anticoagulation during CytoSorb-Therapy does not differ from the usual strategy during CRRT or CBP treatment.

  • Treatment is possible with both, heparin and citrate.
  • An aPTT of...

Treatment with anticoagulation during CytoSorb-Therapy does not differ from the usual strategy during CRRT or CBP treatment.

  • Treatment is possible with both, heparin and citrate.
  • An aPTT of 60-80 seconds for ICU patients or an ACT of 160-210 sec for use within a CPB setup is sufficient for CytoSorb
  • The decision on dosage and target coagulation parameters is left to the discretion of the treating physician.
  • If CytoSorb is used in a stand alone setup, only heparin may be used for anticoagulation. Citrate is contraindicated in this setup.
  • In case of a HIT II, Danaparoid may be used alternatively to Heparin.
  • In case of citrate anticoagulation no particular adjustment needs to be made. Citrate and Calcium are added at the usual sites of the extracorporeal circulation.

May IL- 6 be used as surrogate marker for the effectiveness of the CytoSorb therapy?

The use of IL-6 as surrogate marker for assessment of the patient course is possible. However, the absolute level of the initial value does not necessarily reflect the severity of...

The use of IL-6 as surrogate marker for assessment of the patient course is possible. However, the absolute level of the initial value does not necessarily reflect the severity of the disease.

The course of the IL-6 level must always be considered in the context of the clinical picture of the patient.

  • In case of doubt, the clinical picture of the patient should always be decisive for the indication and effectiveness assessment of the CytoSorb-Therapy.
  • Cytokine levels are meaningful only if assessed over the course of time, but not due to a single determination.
  • After IL-6 blood collection,
    • for immediate measurement, the material must be cooled and transferred to the laboratory immediately.
    • for delayed measurement the material must be deep-frozen.
  • IL-6 has a very short half-life time in the range of minutes.
  • The duration of CytoSorb-Therapy should depend on the clinical course of the patient, not only on single parameters. Significantly decreasing infection markers, less need for catecholamines, the possibility of a negative fluid balance, decreasing invasiveness of ventilation and other factors characterize the improvement of the clinical picture.

Is there a cytokine rebound effect after discontinuation of therapy?

Yes, this can occur under certain circumstances and can be an indicator that

  • the cause for the cytokine release persists (e.g. insufficient focus control) or
  • a new trigger...

Yes, this can occur under certain circumstances and can be an indicator that

  • the cause for the cytokine release persists (e.g. insufficient focus control) or
  • a new trigger for a systemic hyper inflammation has occurred.

There is no specific rebound effect due to the CytoSorb- Therapy itself.