CytoSorb® Hemadsorption in Cardiogenic Shock: A Real-World Analysis of Hemodynamics, Organ Function, and Clinical Outcomes During Mechanical Circulatory Support
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MDPI
Abstract
Cardiogenic shock (CS), characterized by inadequate tissue perfusion due to cardiac dysfunction, has a high mortality rate despite advances in treatment.
Systemic inflammation and organ failure exacerbate the severity of CS. Extracorporeal
hemadsorption techniques such as CytoSorb® have been introduced to control inflammation. However, evidence of their efficacy, particularly in patients on various mechanical
circulatory support (MCS) systems, remains limited. Methods: This retrospective study
analyzed data from 129 CS patients treated with CytoSorb® at the University Hospital of
Marburg between August 2019 and December 2023. Those patients receiving MCS were
grouped according to MCS type: (1) Impella, (2) VA-ECMO, and (3) ECMELLA. The hemodynamic parameters of circulatory support (e.g., MCS flow rates and vasoactive inotropic
score, VIS) and laboratory and ventilation parameters were assessed 24 h before start of
CytoSorb® therapy (T1) and 24 h after completion of CytoSorb® therapy (T2). Results:
Of 129 CS patients (mean age: 64.7 ± 13.1 years), 103 (79.8%) received MCS. Comparing
T1 and T2, there was a significant reduction in VIS in the entire cohort (T1: 38.0, T2: 16.3;
p = 0.002), with a concomitant significant reduction in the level of MCS support in all
subgroups, indicating successful weaning. Analysis of laboratory parameters showed
significant reductions in lactate (T1: 2.1, T2: 1.3 mmol/L; p = 0.014), myoglobin (T1: 1549.0,
T2: 618.0 µg/L; p < 0.01), lactate dehydrogenase (T1: 872.0, T2: 632.0 U/L; p = 0.048), and
procalcitonin (T1: 2.9, T2: 1.6 µg/L; p < 0.001). However, a significant decrease in platelets
(T1: 140.0, T2: 54.0 tsd/µL; p < 0.001) and albumin (T1: 25.0, T2: 22.0 g/dL; p < 0.001) was also
documented. The median SOFA score of the entire cohort was 15.0 (IQR 12.0–16.0), predicting
a mortality rate of >80%, which could be reduced to 60.5% in the present study. Conclusions:
During CytoSorb® therapy in CS, a significant reduction in VIS was demonstrated, resulting
in improved organ perfusion. Therefore, the results of this study underline that CytoSorb®
therapy can be considered a useful “component” in the complex management of CS, especially
when combined with MCS. To refine and optimize treatment strategies in CS, prospective
studies are needed to better define the role of hemadsorption.
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