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Published on: June 12, 2021
CytoSorb® Hemadsorption During Microaxial Flow Pump (mAFP) Support in Cardiogenic Shock: A Propensity Score-Matched
Julian Kreutz1, Klevis Mihali1, Lukas Harbaum1
1Department of Cardiology, Angiology, and Intensive Care Medicine, Philipps-Universität Marburg, Baldingerstraße, 35043 Marburg, Germany.
Insights
Adjunctive CytoSorb hemadsorption improved hemodynamic stability and reduced inflammation in cardiogenic shock patients on microaxial flow pump support. This therapy may benefit high-risk patients by mitigating the inflammatory response.
Area of Science:
- Critical Care Medicine
- Cardiology
- Biomedical Engineering
Background:
- Patients with cardiogenic shock (CS) on temporary mechanical circulatory support (tMCS) using microaxial flow pumps (mAFP) face high mortality rates.
- A dysregulated inflammatory response significantly contributes to multiorgan failure in CS patients.
- CytoSorb hemadsorption is a potential therapy to modulate inflammation, but its efficacy in CS is not well-established.
Purpose of the Study:
- To evaluate the impact of concomitant CytoSorb hemadsorption therapy on patients with CS receiving mAFP support.
- To compare outcomes between CS patients treated with mAFP alone versus mAFP plus CytoSorb.
Main Methods:
- Retrospective, single-center study utilizing propensity score matching (1:1) for 15 patients per group (mAFP with CytoSorb vs. mAFP alone).
- Assessment of hemodynamic, respiratory, and organ function parameters, along with inflammatory markers (procalcitonin).
- Data collected at baseline, and for the CytoSorb group, 24 hours before and after therapy; matched time points used for the control group.
Main Results:
- Patients receiving CytoSorb showed significant improvements in vasoactive-inotropic score, procalcitonin levels, peak inspiratory pressure, and PEEP.
- A significant decline in mAFP flow rates was observed, indicating hemodynamic stabilization.
- The CytoSorb group had a lower in-hospital mortality rate (33.3% vs. 46.7%), though not statistically significant.
Conclusions:
- Adjunctive CytoSorb hemadsorption in CS patients supported by mAFP is associated with improved hemodynamic stability.
- This therapy demonstrated a reduction in the systemic inflammatory burden.
- Findings suggest a potential therapeutic benefit of hemadsorption in this high-risk CS population.
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.
