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Extracorporeal Hemadsorption versus Glucocorticoids during Cardiopulmonary Bypass: A Prospective, Randomized,
Gordana Taleska Stupica1, Maja Sostaric1,2, Marija Bozhinovska1
1Clinical Department of Anaesthesiology and Perioperative Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Insights
Methylprednisolone effectively reduced inflammatory responses after cardiopulmonary bypass (CPB) surgery compared to hemadsorption or usual care. Hemadsorption showed no clinical benefits but altered immune cell markers.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Critical Care Medicine
Background:
- Cardiopulmonary bypass (CPB) surgery triggers significant inflammatory responses.
- Systemic inflammation post-CPB can lead to adverse perioperative outcomes.
- Both glucocorticoids (like methylprednisolone) and extracorporeal hemadsorption are explored to mitigate this inflammation.
Purpose of the Study:
- To compare the efficacy of intraoperative hemadsorption (Cytosorb) versus methylprednisolone in managing inflammatory responses during complex cardiac surgery on CPB.
- To evaluate the impact of these interventions on hemodynamic stability and perioperative clinical outcomes.
Main Methods:
- A randomized trial involving 60 patients undergoing prolonged CPB, allocated to Methylprednisolone, Cytosorb hemadsorption, or Control (usual care) groups.
- Analysis of proinflammatory (TNF-α, IL-1β, IL-6, IL-8) and anti-inflammatory (IL-10) cytokines, complement C5a, and immune cell markers (CD64, CD163) up to postoperative day 5.
- Hemodynamic parameters (cardiac index) and clinical outcomes were also assessed.
Main Results:
- Methylprednisolone significantly reduced TNF-α, IL-6, and IL-8 levels compared to Cytosorb and Control.
- Cytosorb group showed higher prolonged CD64 expression on monocytes, while Methylprednisolone increased IL-10 and CD163 expression.
- No significant differences in cardiac index or clinical outcomes were observed among the groups.
Conclusions:
- Methylprednisolone is more effective than hemadsorption or usual care in ameliorating post-CPB inflammatory responses.
- Hemadsorption, while safe, led to prolonged CD64 expression on monocytes without improving clinical outcomes.
- Further research may be needed to clarify the role of hemadsorption in specific patient populations or inflammatory pathways.
Abstract:
Extracorporeal hemadsorption may reduce inflammatory reaction in cardiopulmonary bypass (CPB) surgery. Glucocorticoids have been used during open-heart surgery for alleviation of systemic inflammation after CPB. We compared intraoperative hemadsorption and methylprednisolone, with usual care, during complex cardiac surgery on CPB, for inflammatory responses, hemodynamics, and perioperative course. Seventy-six patients with prolonged CPB were recruited and randomized, with 60 included in final analysis. Allocation was into three groups: Methylprednisolone (n = 20), Cytosorb (n = 20), and Control group (usual care, n = 20). Proinflammatory (TNF-α, IL-1β, IL-6, and IL-8) and anti-inflammatory (IL-10) cytokines which complement C5a, CD64, and CD163 expression by immune cells were analyzed within the first five postoperative days, in addition to hemodynamic and clinical outcome parameters. Methylprednisolone group, compared to Cytosorb and Control had significantly lower levels of TNF-α (until the end of surgery, p < 0.001), IL-6 (until 48 h after surgery, p < 0.001), and IL-8 (until 24 h after surgery, p < 0.016). CD64 expression on monocytes was the highest in the Cytosorb group and lasted until the 5th postoperative day (p < 0.016). IL-10 concentration (until the end of surgery) and CD163 expression on monocytes (until 48 h after surgery) were the highest in the Methylprednisolone group (p < 0.016, for all measurements between three groups). No differences between groups in the cardiac index or clinical outcome parameters were found. Methylprednisolone more effectively ameliorates inflammatory responses after CPB surgery compared to hemadsorption and usual care. Hemadsorption compared with usual care causes higher prolonged expression of CD64 on monocytes but short lasting expression of CD163 on granulocytes. Hemadsorption with CytoSorb® was safe and well tolerated. This trial is registered with clinicaltrials.gov (NCT02666703).
