Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Int J Artif Organs. 2022 Feb;45(2):216-220. doi: 10.1177/03913988211052572. Epub 2021 Oct 26.
To describe the experience with CytoSorb treatment in patients with refractory acute respiratory distress syndrome (ARDS) following SARS-CoV-2 infection.
Retrospective observational study on 15 patients treated in a University Hospital.
All patients were male, with a mean age of 55 ± 14 years; eight patients (53%) were on venovenous extracorporeal membrane oxygenation (VV ECMO) due to refractory ARDS and all (100%) under mechanical ventilation at the time of CytoSorb use. We observed reduction in the level of C reactive protein (-52%, = 0.002), total bilirubin (-46%, = 0.03), direct bilirubin (-50%, = 0.02), and D-dimers (-39%, = 0.04) during CytoSorb treatment and a trend toward reduction in lactate dehydrogenase (-20%, = 0.2), creatine phosphokinase (-38%, = 0.1), and fibrinogen (-15%, = 0.07). Eight patients died (53%) and seven (47%) were discharged from the ICU, of which five had recovery of the native lung function and two were successfully bridged to lung transplantation on VV ECMO support. No difference between survivors and non-survivors was present at baseline. Patients received three CytoSorb cycles on average: mean duration of CytoSorb cycle was 17 h 21 min, but premature circuit clotting despite appropriate level of systemic anticoagulation was frequently observed.
CytoSorb treatment was effective in improving several laboratory parameters and inflammation in our experience and no treatment-related adverse effects were recorded. In the light of the unique pathophysiology of SARS-CoV-2 infection, CytoSorb treatment is extremely promising, since it might both reduce inflammation and activation of coagulation.
描述 SARS-CoV-2 感染后难治性急性呼吸窘迫综合征（ARDS）患者使用 CytoSorb 治疗的经验。
对一家大学医院收治的 15 例患者进行回顾性观察性研究。
所有患者均为男性，平均年龄 55 ± 14 岁；8 例（53%）因难治性 ARDS 接受静脉-静脉体外膜肺氧合（VV ECMO）治疗，所有患者（100%）在使用 CytoSorb 时均接受机械通气。我们观察到在 CytoSorb 治疗期间 C 反应蛋白（-52%， = 0.002）、总胆红素（-46%， = 0.03）、直接胆红素（-50%， = 0.02）和 D-二聚体（-39%， = 0.04）水平降低，乳酸脱氢酶（-20%， = 0.2）、肌酸磷酸激酶（-38%， = 0.1）和纤维蛋白原（-15%， = 0.07）呈降低趋势。8 例患者死亡（53%），7 例（47%）从 ICU 出院，其中 5 例恢复了原有肺功能，2 例在 VV ECMO 支持下成功桥接肺移植。幸存者和非幸存者在基线时没有差异。患者平均接受 3 个 CytoSorb 循环：CytoSorb 循环的平均持续时间为 17 小时 21 分钟，但尽管给予了适当的全身抗凝水平，仍经常观察到过早的回路凝血。
根据我们的经验，CytoSorb 治疗可有效改善多项实验室参数和炎症，且未记录到与治疗相关的不良反应。鉴于 SARS-CoV-2 感染的独特病理生理学，CytoSorb 治疗极具前景，因为它既能减轻炎症，又能抑制凝血激活。
