Intensive Care Medicine

, Volume 45, Issue 2, pp 236–239 | Cite as

Hemoadsorption with CytoSorb®

  • Elettra C. Poli
  • Thomas Rimmelé
  • Antoine G. SchneiderEmail author
What's New in Intensive Care


Several extracorporeal blood purification techniques have been proposed in critically ill patients with sepsis and sepsis-like syndromes. Despite theoretical benefits, recent Surviving Sepsis Campaign guidelines have not formulated a recommendation in favour of or against such techniques and urged for further research [1]. In this context, CytoSorb® (CytoSorbents Corporation, NJ, USA) was recently licensed for extracorporeal cytokine removal within the European Union (EU).

Cytosorb ® cartridges contain biocompatible polystyrene divinylbenzene copolymer beads capable of adsorbing molecules of medium molecular weight using a combination of size exclusion and hydrophobic interactions [ 2]. They can be used in stand-alone mode (hemoperfusion) or inserted within a continuous renal replacement therapy (CRRT) circuit (associated with a conventional hemofilter), a cardiopulmonary bypass (CPB) or an extracorporeal membrane oxygenation circuit. CytoSorb ® (Fig.  1) removes a wide range...


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Conflicts of interest

EP has not disclosed any potential conflict of interest. TR has received speaker and consulting honoraria from Fresenius Medical Care, Baxter Healthcare Corp, Biomérieux, Medtronic and B. Braun. AS has received a grant from the Leenaards Foundation, speaker honoraria from Fresenius Medical Care, Baxter Healthcare Corp and consulting honoraria from B. Braun Melsungen AG. He is the principal investigator of the CCCC trial, a pilot trial evaluating the impact of Cytosorb during cardiac surgery ( (NCT02775123).


  1. 1.
    Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, Rochwerg B, Rubenfeld GD, Angus DC, Annane D, Beale RJ, Bellinghan GJ, Bernard GR, Chiche J-D, Coopersmith C, De Backer DP, French CJ, Fujishima S, Gerlach H, Hidalgo JL, Hollenberg SM, Jones AE, Karnad DR, Kleinpell RM, Koh Y, Lisboa TC, Machado FR, Marini JJ, Marshall JC, Mazuski JE, McIntyre LA, McLean AS, Mehta S, Moreno RP, Myburgh J, Navalesi P, Nishida O, Osborn TM, Perner A, Plunkett CM, Ranieri M, Schorr CA, Seckel MA, Seymour CW, Shieh L, Shukri KA, Simpson SQ, Singer M, Thompson BT, Townsend SR, Van der Poll T, Vincent J-L, Wiersinga WJ, Zimmerman JL, Dellinger RP (2017) Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43:304–377CrossRefGoogle Scholar
  2. 2.
    Malard B, Lambert C, Kellum JA (2018) In vitro comparison of the adsorption of inflammatory mediators by blood purification devices. Intensive Care Med Exp 6:12CrossRefGoogle Scholar
  3. 3.
    Gruda MC, Ruggeberg KG, O’Sullivan P, Guliashvili T, Scheirer AR, Golobish TD et al (2018) Broad adsorption of sepsis-related PAMP and DAMP molecules, mycotoxins, and cytokines from whole blood using CytoSorb® sorbent porous polymer beads. PLoS One 13:e0191676CrossRefGoogle Scholar
  4. 4.
    Gemelli C, Cuoghi A, Magnani S, Atti M, Ricci D, Siniscalchi A, Mancini E, Faenza S (2018) Removal of bilirubin with a new adsorbent system: in vitro kinetics. Blood Purif.
  5. 5.
    Peng Z-Y, Carter MJ, Kellum JA (2008) Effects of hemoadsorption on cytokine removal and short-term survival in septic rats. Crit Care Med 36:1573–1577CrossRefGoogle Scholar
  6. 6.
    Kellum JA, Song M, Venkataraman R (2004) Hemoadsorption removes tumor necrosis factor, interleukin-6, and interleukin-10, reduces nuclear factor-kappaB DNA binding, and improves short-term survival in lethal endotoxemia. Crit Care Med 32:801–805CrossRefGoogle Scholar
  7. 7.
    Schädler D, Pausch C, Heise D, Meier-Hellmann A, Brederlau J, Weiler N, Marx G, Putensen C, Spies C, Jörres A, Quintel M, Engel C, Kellum JA, Kuhlmann MK (2017) The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: a randomized controlled trial. PLoS One 12:e0187015CrossRefGoogle Scholar
  8. 8.
    Friesecke S, Träger K, Schittek GA, Molnar Z, Bach F, Kogelmann K, Bogdanski R, Weyland A, Nierhaus A, Nestler F, Olboeter D, Tomescu D, Jacob D, Haake H, Grigoryev E, Nitsch M, Baumann A, Quintel M, Schott M, Kielstein JT, Meier-Hellmann A, Born F, Schumacher U, Singer M, Kellum J, Brunkhorst FM (2017) International registry on the use of the CytoSorb® adsorber in ICU patients. Med Klin Intensivmed Notfmed.
  9. 9.
    Friesecke S, Stecher S-S, Gross S, Felix SB, Nierhaus A (2017) Extracorporeal cytokine elimination as rescue therapy in refractory septic shock: a prospective single-center study. J Artif Organs 20:252–259CrossRefGoogle Scholar
  10. 10.
    Kogelmann K, Jarczak D, Scheller M, Drüner M (2017) Hemoadsorption by CytoSorb in septic patients: a case series. Crit Care 21:74CrossRefGoogle Scholar
  11. 11.
    Bernardi MH, Rinoesl H, Dragosits K, Ristl R, Hoffelner F, Opfermann P, Lamm C, Preißing F, Wiedemann D, Hiesmayr MJ, Spittler A (2016) Effect of hemoadsorption during cardiopulmonary bypass surgery—a blinded, randomized, controlled pilot study using a novel adsorbent. Crit Care 20:96CrossRefGoogle Scholar
  12. 12.
    Nemeth E, Kovacs E, Racz K, Soltesz A, Szigeti S, Kiss N, Csikos G, Koritsanszky KB, Berzsenyi V, Trembickij G, Fabry S, Prohaszka Z, Merkely B, Gal J (2018) Impact of intraoperative cytokine adsorption on outcome of patients undergoing orthotopic heart transplantation—an observational study. Clin Transplant 32:e13211CrossRefGoogle Scholar
  13. 13.
    Träger K, Skrabal C, Fischer G, Datzmann T, Schroeder J, Fritzler D, Hartmann J, Liebold A, Reinelt H (2017) Hemoadsorption treatment of patients with acute infective endocarditis during surgery with cardiopulmonary bypass—a case series. Int J Artif Organs 40:240–249CrossRefGoogle Scholar
  14. 14.
    Träger K, Fritzler D, Fischer G, Schröder J, Skrabal C, Liebold A, Reinelt H (2016) Treatment of post-cardiopulmonary bypass SIRS by hemoadsorption: a case series. Int J Artif Organs 39:141–146CrossRefGoogle Scholar
  15. 15.
    Reiter K, Bordoni V, Dall’Olio G, Grazia Ricatti M, Soli M, Ruperti S, Soffiati G, Galloni E, D’Intini V, Bellomo R, Ronco C (2002) In vitro removal of therapeutic drugs with a novel adsorbent system. Blood Purif 20(4):380–388Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Elettra C. Poli
    • 1
  • Thomas Rimmelé
    • 2
    • 3
  • Antoine G. Schneider
    • 1
    Email author
  1. 1.Service de Médecine Intensive AdulteCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
  2. 2.Service d’anesthésie-réanimationHôpital Edouard HerriotLyonFrance
  3. 3.EA 7426 PI3 (Pathophysiology of Injury-Induced Immunosuppression)Université Claude Bernard Lyon I-Biomérieux-Hospices Civils de LyonLyonFrance

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