CytoSorb® Hemadsorption During Microaxial Flow Pump (mAFP) Support in Cardiogenic Shock: A Propensity Score-Matched Cohort Study
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MDPI
Abstract
Background: Despite advances in temporary mechanical circulatory support (tMCS),
patients with cardiogenic shock (CS) who are treated with a microaxial flow pump (mAFP;
Impella®, Abiomed) still have a high mortality rate. A dysregulated systemic inflammatory
response significantly contributes to multiorgan failure in this population. CytoSorb®
hemadsorption has emerged as a potential adjunctive therapy for modulating inflammation,
but data on its use in CS are limited. Methods: This retrospective, single-center study
used propensity score matching analysis (1:1 matching; n = 15 per group) to compare the
outcomes of patients receiving mAFP support with and without concomitant CytoSorb
therapy. Baseline data (T0), including comorbidities and clinical status at ICU admission,
were collected for all patients. In the CytoSorb group, data were collected at two additional
time points: 24 h before the start of CytoSorb therapy (T1), and 24 h after its completion (T2).
At these time points, laboratory values and parameters on respiratory, hemodynamic, and
organ function were assessed. Corresponding data were also collected for matched patients
in the non-CytoSorb group at equivalent time points relative to their matched counterparts.
Results: In the propensity score-matched cohort, patients treated with CytoSorb exhibited
significant improvements between T1 and T2. Specifically, reductions were observed in
the vasoactive-inotropic score (p = 0.035), procalcitonin levels (p = 0.041), peak inspiratory
pressure (p = 0.036), and positive end-expiratory pressure (p = 0.016). Flow rates through the
mAFP declined significantly (p = 0.014), suggesting stabilization of hemodynamics. These
changes were not observed in the non-CytoSorb group, where most parameters remained
unchanged or exhibited less pronounced trends. We observed a lower in-hospital mortality
rate in the CytoSorb group (33.3% versus 46.7%), though the difference was not significant,
potentially due to limited statistical power. Conclusions: CytoSorb hemadsorption in
mAFP-supported CS was associated with improved hemodynamic stability and reduced
inflammatory burden. These findings suggest a potential therapeutic benefit of adjunctive
hemadsorption in this high-risk population.
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Except where otherwise noted, this item's license is described as Attribution 4.0 International