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Hemoperfusion in Cardiac Surgery and ECMO.

Paul Abraham1,2, Vitor Mendes2, Matthias Kirsch2,3

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Contributions to Nephrology
|June 1, 2023
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Summary

Hemoperfusion, a blood purification technique, may mitigate immune system activation during extracorporeal circulation (ECC). While feasible and safe in cardiac surgery, further studies are needed to confirm its clinical benefits and indications.

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Area of Science:

  • Immunology
  • Cardiovascular Surgery
  • Blood Purification Technologies

Background:

  • Extracorporeal circulation (ECC), including cardiopulmonary bypass and ECMO, can trigger a complex immune response.
  • Current strategies to manage ECC-induced immune activation have not significantly improved clinical outcomes.
  • Hemoperfusion offers a theoretical advantage by removing excess inflammatory molecules via hemoadsorption.

Purpose of the Study:

  • To discuss the rationale for using hemoperfusion with ECC.
  • To outline the practical application of hemoperfusion during ECC.
  • To review the current evidence supporting hemoperfusion therapy in ECC and ECMO.

Main Methods:

  • Hemoperfusion involves integrating a hemoadsorption cartridge into the extracorporeal circuit.
  • This technique utilizes mass separation via a solid adsorptive sorbent.
  • Studies reviewed include those demonstrating feasibility and safety in cardiac surgery and preliminary data in ECMO.

Main Results:

  • Hemoperfusion has been shown to be feasible and safe during cardiac surgery.
  • Preliminary studies suggest hemoperfusion can reduce elevated cytokine levels.
  • Data on hemoperfusion during ECMO is limited and yields conflicting results.

Conclusions:

  • Hemoperfusion is a potential strategy to mitigate immune activation during ECC.
  • Further research is essential to establish clinical indications, optimal timing, and duration for hemoperfusion in cardiac surgery.
  • More robust data is needed to evaluate hemoperfusion's role in ECMO.