Early initiation of hemoadsorption reduces the need for organ support in critically ill COVID-19 patients on ECMO: A post-hoc analysis from the CytoSorb Therapy in COVID-19 (CTC) Registry

Objectives: Preliminary results of the CTC Registry on the first 52 patients showed survival of 69% at 90 days [1]. The current exploratory analysis aimed to examine whether the time of initiation of hemoadsorption (i.e.: early vs late) had any effect organ support requirements and survival. Method(s): We included all 100 patients recruited in the CTC Registry in 5 U.S. intensive care units (ICU). The median time from ICU admission to the start of hemoadsorption was 86.7 h. We created two post hoc groups: <=86.7 h (group-early, GE) and >86.7 h (group-late, GL) and compared outcomes with special focus on the need of mechanical ventilation (MV), vasopressor, renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO). Result(s): There was no difference between groups in baseline characteristics. 90-day survival was 78% in GE and 62% in GL (p=0.08). Patients in the GL vs GE spent longer time on ECMO (p=0.021), mechanical ventilation (p=0.02) and needed significantly longer ICU-stay (p=0.002), (Fig. 1). There was also a trend for longer vasopressor support (8 [4-21] vs 4 [1-17] days, p=0.13). There was no significant difference between the groups regarding the need of CRRT. Conclusion(s): The current analysis shows that early initiation of hemoadsorption with ECMO in critically ill COVID-19 patients is associated with shorter duration of organ support measures and shorter ICU stays.

BUILDING A REUSABLE DATA MODEL TO SUPPORT SYSTEMATIC LAY- OUT PLANNING WITH DISCRETE EVENT SIMULATION OF FLEXIBLE MANUFACTURING SYSTEMS

Manufacturing has undergone a greater change in recent years than it has over almost the entire past century. Due to the variety of products, shortening delivery times and changing customer habits, the COVID-19 pandemic has demanded greater flexibility from manufacturing companies than ever before. One of the fundamental parts of manufacturing flexibility is the design of manufacturing layouts, which has so far not followed automation and methodological developments with regard to technological areas of manufacturing. In this article, a new method for supporting traditional factory design methods with digital manufacturing tools is introduced.

Relationship of lung oxygenation to timing of hemoadsorption therapy initiation in COVID-19 patients requiring extracorporeal mechanical oxygenation (ECMO): an observational analysis from the CytoSorb therapy in COVID-19 (CTC) Registry

Introduction: The multicenter CTC Registry study collected patientlevel data in COVID-19 patients receiving CytoSorb therapy under FDA Emergency Use Authorization. An earlier report on the first 52 CTC patients on ECMO treated with CytoSorb showed 69% overall survival [1]. The current analysis focuses on changes in pulmonary function relative to the time of CytoSorb therapy. Methods: A total of 56 patients from 5 U.S. centers were included. Data on demographics, mechanical ventilation (MV), ECMO, and arterial blood gases during CytoSorb therapy were analyzed. Linear regression was used to evaluate the relationship between the timing of initiation of CytoSorb therapy to lung oxygenation according to changes in PaO2/FiO2 ratio. Results: In the current analysis, 71% (40/56) overall survival was observed. For these survivors, time to CytoSorb start after ICU admission, MV start, and ECMO start was 138 ± 171.3 h, 83 ± 111.0 h, and 55 ± 156.5 h, respectively, with mean duration of CytoSorb therapy of 83 ± 29.1 h. At the first 24 h following CytoSorb therapy, oxygenation was improved evidenced by decreased MV FiO2 and ECMO FdO2 requirements and an increased PaO2/FiO2 ratio (90.2 ± 58.13 mmHg to 166.3 ± 98.67 mmHg, p < 0.001, N = 21). Linear regression analysis suggested that earlier initiation of CytoSorb therapy following ICU admission may be correlated to greater improvements in PaO2/FiO2 ratio (r = -0.37, p = 0.103), however, this trend did not achieve statistical significance. Conclusions: High survival rates have been observed with adjunct CytoSorb therapy in critically ill COVID-19 patients on ECMO. The current analysis suggests that early initiation of hemoadsorption following ICU admission may contribute to earlier improvements in native lung oxygenation.