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Cytokine Hemoadsorption versus Standard Care in Cardiac Surgery Using the Oxiris Membrane: The OXICARD Single-center
Osama Abou-Arab1, Pierre Huette2, Azrat Ibrahima2
1Anesthesia and Critical Care Department, Amiens University Hospital, Amiens, France; EA7517, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications (MP3CV), Jules Verne University of Picardie, Amiens, France.
Insights
Hemadsorption with the Oxiris membrane did not improve microcirculation or reduce adverse cardiovascular events in high-risk cardiac surgery patients. Further research is needed to explore its potential benefits in specific inflammatory conditions.
Area of Science:
- Cardiology
- Critical Care Medicine
- Biomaterials Science
Background:
- Cardiac surgery can induce a proinflammatory state, leading to adverse outcomes.
- The Oxiris membrane (AN-69) possesses properties to chelate inflammatory cytokines.
- This study investigated the Oxiris membrane's potential to mitigate inflammation and improve outcomes in high-risk cardiac surgery.
Purpose of the Study:
- To evaluate the efficacy of the Oxiris membrane in reducing inflammation during cardiac surgery.
- To assess the impact of Oxiris membrane use on endothelial function and microcirculation.
- To determine if Oxiris membrane treatment improves postoperative outcomes in high-risk patients.
Main Methods:
- A randomized single-center study involving adult patients undergoing scheduled cardiac surgery with expected cardiopulmonary bypass (CPB) >90 minutes.
- Patients were assigned to either a standard group or an Oxiris group, with the intervention group receiving Oxiris membrane treatment during CPB.
- Primary outcome: sublingual microcirculation assessed by microvascular flow index (MFI) on postoperative day 1. Secondary outcome: composite adverse events within 30 days.
Main Results:
- No significant difference in microvascular flow index was observed between the Oxiris and standard groups on postoperative day 1 (P=0.2).
- The incidence of composite adverse outcomes within 30 days did not differ significantly between the groups (42% vs. 35%, P=0.7).
- No significant differences were found in the variation of cytokines and angiopoietins between the groups.
Conclusions:
- The use of the Oxiris membrane during prolonged CPB in cardiac surgery did not demonstrate a benefit in improving microcirculation.
- The study failed to show a significant reduction in major cardiovascular events with Oxiris membrane treatment.
- Further investigation is warranted to identify specific patient populations or conditions where Oxiris membrane hemadsorption may offer clinical advantages.
Background:
Cardiac surgery can lead to dysregulation with a proinflammatory state, resulting in adverse outcomes. Hemadsorption using the AN-69 membrane (Oxiris membrane, Baxter, USA) has the properties to chelate inflammatory cytokines. The authors hypothesized that in patients at high risk of inflammation, the use of the Oxiris membrane could decrease inflammation, preserve endothelial function, and improve postoperative outcomes.
Methods:
The authors conducted a randomized single-center study at Amiens University Hospital (Amiens, France). The study population consisted of adult patients admitted for scheduled cardiac surgery with an expected cardiopulmonary bypass (CPB) time greater than 90 min. The patients were allocated to either the standard group or the Oxiris group. The intervention consisted of using the Oxiris membrane on a Prismaflex device (Baxter, USA) at a blood flow rate of 450 ml/min during CPB. The primary outcome was the assessment of microcirculation on day 1 after surgery by measuring sublingual microcirculation using the microvascular flow index. Microvascular flow index reflects the microcirculation flow type and is graded from 0 to 3 as follows: 0, no flow; 1, intermittent flow; 2, sluggish flow; 3, continuous flow. The secondary outcome was a composite adverse outcome within 30 days after surgery. Cytokines and endothelial biomarkers were measured in all patients at different time points. An intention-to-treat analysis was performed.
Results:
From October 2019 to November 2022, the study included 70 patients. Two patients were excluded from the Oxiris group: one patient did not undergo surgery, and one procedure was performed under deep hypothermia. The microvascular flow index did not differ between groups on day 1 from baseline: difference (95% CI) Oxiris minus standard at -0.17 (-0.44 to 0.10); P = 0.2. The occurrence of a composite adverse outcome did not significantly differ between groups (14 [42%] for the Oxiris group vs. 12 [35%] for the standard group; P = 0.7). The overall variation in cytokines and angiopoietins did not significantly differ between groups.
Conclusions:
In patients scheduled for a cardiac surgery with prolonged CPB, the authors could not demonstrate the benefit on microcirculation and major cardiovascular events.
