CytoSorb Therapy – An adjunctive method in COVID-19 therapy
The COVID-19 pandemic is a global health problem.
Knowledge of the virus and its infectivity, as well as treatment methods have made rapid progress over the last year and half.
However, there are still limited options to effectively treat critically ill patients.
Schematic overview of COVID-19 clinical management:
CytoSorb is an adjunctive method in COVID-19 therapy to remove cytokines which are known to cause endothelial damage and several other complications in COVID-19 pathophysiology.
Inflammation, edema, and hypercoagulation play a detrimental role
The acute inflammatory and thrombo-inflammatory response to COVID-19 impairs tissue microcirculation causing injury initially in the lung and then cascade to other organs.
Action of CytoSorb-Therapy
CytoSorb advanced blood purification therapy removes cytokines which are pathologically elevated and can support to normalize or balance cytokine levels.
CytoSorb removes excessive levels of cytokines, bilirubin and/or myoglobin.
CytoSorb has shown in clinical studies:
- minimal removal of important substances such as albumin, platelets or coagulation factors,
- no activation of coagulation and complement system.
Benefits
Microcirculation improvement
Weaning from ECMO support in Severe Pneumogenic Sepsis patients
“The mean duration of ECMO support was 8,2 days
(range: 2–23 days) in the CytoSorb group and 19,3
(range: 13–30 days) in the control group.”
Early Intervention with CytoSorb is Key
Early start with CytoSorb in appropriately selected patients where elevated levels of cytokines induce and fuel complications, appears to be critically important.
The removal of these elevated cytokines may help to prevent these complications of inflammation.
Inflammatory changes are potentially avoidable and even reversable, consecutive damages of tissues or organs with apoptotic or necrotic cells are not.
Clinical experience shows that the clinical course of the disease could progress in waves.
CytoSorb must be started before irreversible deterioration occurs or point of no return has been passed.
Proper patient selection, timing and dosing are crucial for the success of the CytoSorb-Therapy
Patient selection
Published studies and clinical use
have shown that CytoSorb can be
beneficial in patients with:
- ARDS, before intubation (6)
- ARDS, intubated, with/ without kidney failure (1,4,7)
- Refractory vasoplegic shock with kidney failure (4)
- VV-ECMO (7,8)
Timing
Early Intervention with
CytoSorb is key. CytoSorb Therapy must be started:
- Before irreversible deterioration occurs or
- Point of no return has been passed
Dosing
Administration of therapy:
-
Day 1
two devices for
12 hrs. each -
Day 2/3
one device for
24 hrs. each - Re-evaluation
Easy integration on extracorporeal platforms
CytoSorb can be integrated into many extracorporeal circuits:
- Renal replacement therapy circuits (CRRT, SLED, intermittent dialysis)
- Various ECMO systems (Extracorporeal Membrane Oxygenation) and
- Hemoperfusion machines
CytoSorb has a safe and easy set-up in minutes.
- Simple saline flushing appropriate
- Routine anticoagulation compatible (heparin, citrate)
Recommendations & Guidelines
Several medical societies globally have recommended CytoSorb as adjunctive therapy in critically ill COVID patients.
The FDA in USA granted CytoSorb Therapy Emergency Use Authorization for use in critically-ill COVID-19 patients with imminent or confirmed respiratory failure.
CytoSorb Therapy listed for non drug life support in COVID-19 patients (9)
Latest clinical results
Data from the CytoSorb Therapy in COVID-19 (CTC) on ECMO registry, a multi-center, observational registry in the US (10), showed that:
- CytoSorb Therapy was easy to use and safe without any unanticipated adverse events reported,
- CytoSorb + ECMO ICU survival at 90 days was higher than the ECMO alone, as reported in the ELSO Registry (11)
September 10, 2021
CytoSorbents Webinar: CTC Multicenter Registry | CytoSorb Therapy with ECMO in COVID-19
October 28, 2021
8th International CytoSorb Users Meeting | CytoSorb-Therapy in COVID-19 patients
October 28, 2021
8th International CytoSorb Users Meeting | CytoSorb-Therapy in COVID-19 patients
References
- Nassiri A A et al., Artif Organs. 2021 Nov;45(11):1338-1347
- Zuccari S. et al. Blood Purif 2019;47(suppl 4):3–37
- David S. et al. Journal of Intensive Care (2017) 5:12
- Alharthy A et al., Artif Organs. 2021 May;45(5):E101-E112
- Akil A., et al., Thorac Cardiovasc Surg. 2021 Apr;69(3):246-251
- Rampino T, et al., Blood Purif. 2021;50(4-5):566-571
- Wunderlich-Sperl F., et al. Int J Artif Organs. 2021 Oct;44(10):694-702
- Song T, et al., Crit Care 2021, 25(Suppl 1):383
- WHO COVID Classification of treatment types; 28 April 2020
- Song T et al., Front Med 2021; 8:773461
- ELSO COVID-19 ECMO Registry ARDS cohort – May 25, 2021