ABSTRACT
Extracorporeal membrane oxygenation (ECMO) is frequently used in many centers around the globe for various indications. However, prognosis is often poor even with all supportive therapies, and in many cases, clinical deterioration is associated with inflammation. Hemoadsorption with CytoSorb is a novel approach to limit the inflammatory response, and the device can be safely and easily installed into ECMO circuits. CytoSorb has been used more than 130.000 times to date, but because randomized controlled trials are largely lacking, there is substantial debate on its use. Here, experts from critical care medicine, cardiology, cardiac surgery, and perfusion technology discuss the pros and cons of this novel therapy and outline the future aspects for its clinical application and research.
Subject(s)
Extracorporeal Membrane Oxygenation/methods , Hemofiltration/instrumentation , Absorption, Physicochemical , Extracorporeal Membrane Oxygenation/adverse effects , Hemofiltration/methods , Humans , InflammationSubject(s)
COVID-19/complications , Cytokine Release Syndrome/therapy , Immunomodulation , Membranes, Artificial , SARS-CoV-2 , Adsorption , COVID-19/immunology , Cytokine Release Syndrome/etiology , Hemofiltration/instrumentation , Hemofiltration/methods , Humans , Isoelectric Point , Systemic Inflammatory Response Syndrome/etiology , Systemic Inflammatory Response Syndrome/therapyABSTRACT
The real issue with the COVID-19 pandemic is that a rapidly increasing number of patients with life-threatening complications are admitted in hospitals and are not well-administered. Although a limited number of patients use the intensive care unit (ICU), they consume medical resources, safety equipment, and enormous equipment with little possibility of rapid recovery and ICU discharge. This work reviews effective methods of using filtration devices in treatment to reduce the level of various inflammatory mediators and discharge patients from the ICU faster. Extracorporeal technologies have been reviewed as a medical approach to absorb cytokines. Although these devices do not kill or remove the virus, they are a promising solution for treating patients and their faster removal from the ICU, thus relieving the bottleneck.