HA-330 hemoadsorption in septic shock requiring high-dose norepinephrine: a multicenter randomized controlled trial...

Area of Science:

• Critical Care Medicine
• Nephrology
• Extracorporeal Therapies

Background:

• Septic shock involves inflammatory cytokines, leading to tissue injury and circulatory failure.
• Hemoadsorption is an extracorporeal method to remove these inflammatory mediators.
• Optimizing patient selection and treatment timing is crucial for hemoadsorption efficacy.

Purpose of the Study:

• To evaluate if adjunctive hemoadsorption using the HA-330 cytokine adsorber decreases 28-day mortality in septic shock patients.
• Comparison was made against standard treatment alone in patients requiring high-dose vasopressors.

Main Methods:

• A multicenter, randomized controlled trial was conducted in Thailand.
• Patients with septic shock needing high-dose norepinephrine were randomized to standard treatment or standard treatment plus HA-330 hemoadsorption.
• The trial was stopped early due to slow recruitment and funding issues.

Main Results:

• 128 patients were enrolled; 65 received standard treatment, 63 received hemoadsorption.
• 28-day mortality was 58% in the standard treatment group versus 44% in the hemoadsorption group (RR 0.76, P=0.16).
• No significant differences were found in other clinical outcomes, though a post-hoc analysis suggested a mortality benefit (HR 0.62, P=0.037).

Conclusions:

• Adjunctive hemoadsorption with HA-330 did not achieve statistical significance in reducing 28-day mortality in this early-terminated trial.
• The study suggests that hemoadsorption may not be effective for all septic shock patients requiring high-dose vasopressors.
• Further research with adequate sample size is needed to confirm potential benefits and optimal use of hemoadsorption in sepsis.