Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
Thoracic Surgery Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
Crit Care. 2023 Jan 23;27(1):36. doi: 10.1186/s13054-023-04323-x.
Hemoadsorption (HA) might mitigate the systemic inflammatory response associated with post-cardiac arrest syndrome (PCAS) and improve outcomes. Here, we investigated the feasibility, safety and efficacy of HA with CytoSorb in cardiac arrest (CA) survivors at risk of PCAS.
In this pilot randomized controlled trial, we included patients admitted to our intensive care unit following CA and likely to develop PCAS: required norepinephrine (> 0.2 µg/kg/min), and/or had serum lactate > 6 mmol/l and/or a time-to-return of spontaneous circulation (ROSC) > 25 min. Those requiring ECMO or renal replacement therapy were excluded. Eligible patients were randomly allocated to either receive standard of care (SOC) or SOC plus HA. Hemoadsorption was performed as stand-alone therapy for 24 h, using CytoSorb and regional heparin-protamine anticoagulation. We collected feasibility, safety and clinical data as well as serial plasma cytokines levels within 72 h of randomization.
We enrolled 21 patients, of whom 16 (76%) had out-of-hospital CA. Median (IQR) time-to-ROSC was 30 (20, 45) minutes. Ten were assigned to the HA group and 11 to the SOC group. Hemoadsorption was initiated in all patients allocated to the HA group within 18 (11, 23) h of ICU admission and conducted for a median duration of 21 (14, 24) h. The intervention was well tolerated except for a trend for a higher rate of aPTT elevation (5 (50%) vs 2 (18%) p = 0.18) and mild (100-150 G/L) thrombocytopenia at day 1 (5 (50%) vs 2 (18%) p = 0.18). Interleukin (IL)-6 plasma levels at randomization were low (< 100 pg/mL) in 10 (48%) patients and elevated (> 1000 pg/mL) in 6 (29%). The median relative reduction in IL-6 at 48 h was 75% (60, 94) in the HA group versus 5% (- 47, 70) in the SOC group (p = 0.06).
In CA survivors at risk of PCAS, HA was feasible, safe and was associated with a nonsignificant reduction in cytokine plasma levels. Future trials are needed to further define the role of HA after CA. Those studies should include cytokine assessment to enrich the study population.
NCT03523039, registered 14 May 2018.
血液吸附（HA）可能减轻与心搏骤停后综合征（PCAS）相关的全身炎症反应，并改善预后。在此，我们研究了 HA 联合 CytoSorb 在有发生 PCAS 风险的心脏骤停（CA）幸存者中的可行性、安全性和疗效。
在这项先导性随机对照试验中，我们纳入了因 CA 而入住我院重症监护病房且可能发生 PCAS 的患者：需要去甲肾上腺素（>0.2μg/kg/min），或血清乳酸>6mmol/L，或自主循环恢复时间（ROSC）>25min。排除需要 ECMO 或肾脏替代治疗的患者。符合条件的患者被随机分配接受标准治疗（SOC）或 SOC 加 HA。血液吸附作为单独的治疗方法，持续 24h，使用 CytoSorb 和局部肝素-鱼精蛋白抗凝。我们在随机分组后 72h 内收集可行性、安全性和临床数据以及连续的血浆细胞因子水平。
我们共纳入 21 例患者，其中 16 例（76%）为院外 CA。ROSC 的中位（IQR）时间为 30（20，45）min。10 例患者被分配到 HA 组，11 例患者被分配到 SOC 组。所有被分配到 HA 组的患者均在 ICU 入院后 18（11，23）h 内开始 HA，中位治疗时间为 21（14，24）h。除 aPTT 升高的趋势较高（5（50%）比 2（18%），p=0.18）和轻度（100-150G/L）血小板减少在第 1 天（5（50%）比 2（18%），p=0.18）外，该干预措施耐受性良好。在随机分组时，10 例（48%）患者的白细胞介素（IL）-6 血浆水平较低（<100pg/mL），6 例（29%）患者的 IL-6 血浆水平升高（>1000pg/mL）。在 HA 组，48h 时 IL-6 的中位相对降低率为 75%（60，94），而 SOC 组为 5%（-47，70）（p=0.06）。
在有发生 PCAS 风险的 CA 幸存者中，HA 是可行的、安全的，并且与细胞因子血浆水平的非显著性降低相关。需要进一步的试验来进一步确定 CA 后 HA 的作用。这些研究应包括细胞因子评估，以丰富研究人群。
NCT03523039，于 2018 年 5 月 14 日注册。
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