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Critical Care

, 23:343 | Cite as

Hemoadsorption efficacy for uncomplicated high-risk cardiac surgery

  • Sébastien Redant
  • Matthieu Legrand
  • Yael Langman
  • Alejandra Garcia Aguilar
  • François Angoulvant
  • Keitiane Kaefer
  • David De Bels
  • Rachid Attou
  • Kianoush Kashani
  • Patrick M. HonoreEmail author
Open Access
Letter
  • 311 Downloads

Abbreviations

CBP

Cardiopulmonary bypass

IL-6

Interleukin-6

IL-8

Interleukin-8

SI

Systemic inflammation

We enthusiastically read the paper by Poli et al. related to the use of CytoSorb® in high-risk cardiac surgery. While use of CytoSorb® showed no clinical or laboratory benefit, it was not associated with any complications either [1]. We noted the low level of interleukin-6 (IL-6) reported in this study (i.e., median values < 50 pg/ml and < 200 pg/ml during and after CBP). This observation may explain why there was no obvious benefit. In the paper by Träger et al., a series of 16 post-cardiac surgery patients with systemic inflammation (SI) characterized by a mixture of cardiogenic shock and distributive shock with acute kidney injury requiring continuous renal replacement therapy were enrolled. The authors observed patients prior to treatment with CytoSorb® to have baseline IL-6 and IL-8 levels between 500 and 10,000 pg/mL and 50 and 1000 pg/mL, respectively. Along with a decrease in the interleukin levels, hemodynamic parameters including cardiac index and mean arterial pressure improved and the need for catecholamine declined [2]. The same benefit was observed when CytoSorb® was used intraoperatively for patients with endocarditis. These patients had a high level of IL-6 and IL-8 prior to the intervention [3]. It is also reported that among septic patients with elevated IL-6 (> 1000 pg/mL) requiring continuous renal replacement therapy, cytokine clearance was more efficient when hemoperfusion and hemoadsorption were utilized [4]. Patients with a significant preoperative SI, such as in endocarditis or sepsis or with complicated surgery, are the most likely to benefit from CytoSorb® therapy. We agree with the authors that some cardiac surgery patients might benefit from hemoadsorption device, but we believe that the indication should be tested in patients with a high level of circulating cytokines—such as IL-6 [5].

Notes

Acknowledgements

None.

Authors’ contributions

SR, KK, and PMH designed the paper. All authors participated in drafting and reviewing. All authors read and approved the final version of the manuscript.

Funding

None.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

References

  1. 1.
    Poli EC, Alberio L, Bauer-Doerries A, Marcucci C, Roumy A, Kirsch M, et al. Cytokine clearance with CytoSorb® during cardiac surgery: a pilot randomized controlled trial. Crit Care. 2019;23(1):108.  https://doi.org/10.1186/s13054-019-2399-4.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Träger K, Fritzler D, Fischer G, Schröder J, Skrabal C, Liebold A, et al. Treatment of post-cardiopulmonary bypass SIRS by hemoadsorption: a case series. Int J Artif Organs. 2016;39(3):141–6.  https://doi.org/10.5301/ijao.5000492.CrossRefPubMedGoogle Scholar
  3. 3.
    Träger K, Skrabal C, Fischer G, Datzmann T, Schroeder J, Fritzler D, et al. Hemoadsorption treatment of patients with acute infective endocarditis during surgery with cardiopulmonary bypass - a case series. Int J Artif Organs. 2017;40(5):240–9.  https://doi.org/10.5301/ijao.5000583.CrossRefPubMedGoogle Scholar
  4. 4.
    Schädler D, Pausch C, Heise D, Meier-Hellmann A, Brederlau J, Weiler N, et al. The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: a randomized controlled trial. PLoS One. 2017;12(10):e0187015.  https://doi.org/10.1371/journal.pone.0187015.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Honore PM, Hoste E, Molnar Z, Jacobs R, Joannes-Boyau O, Malbrain MLN, Forni L. Cytokine removal in human septic shock: where are we and where are we going? Ann of Intensive Care. 2019;9(1):56.  https://doi.org/10.1186/s13613-019-0530-y.CrossRefGoogle Scholar

Copyright information

© The Author(s). 2019

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Sébastien Redant
    • 1
  • Matthieu Legrand
    • 2
  • Yael Langman
    • 1
  • Alejandra Garcia Aguilar
    • 3
  • François Angoulvant
    • 4
  • Keitiane Kaefer
    • 1
  • David De Bels
    • 1
  • Rachid Attou
    • 1
  • Kianoush Kashani
    • 5
  • Patrick M. Honore
    • 1
    Email author
  1. 1.ICU DepartmentCentre Hospitalier Universitaire Brugmann-Brugmann University HospitalBrusselsBelgium
  2. 2.Department of Anesthesiology, Critical Care and Burn Unit, St. Louis HospitalUniversity Paris 7 Denis Diderot, UMR-S942, InsermParisFrance
  3. 3.Hospital General de Zona No. 14 IMSSUniversidad Autónoma de GuadalajaraGuadalajaraMexico
  4. 4.Service d’accueil des Urgences Pédiatriques, Necker-Enfants Malades University HospitalAssistance Publique–Hôpitaux de ParisParisFrance
  5. 5.Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterUSA

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