Introduction
Methods
Results
Study search
Study characteristics
First author | Year | Study design | Patient characteristics | Treatment scheme | N (CytoSorb®/Control) | Age (CytoSorb®/Control) M or Md | Sex (% male) (CytoSorb®/Control) |
---|---|---|---|---|---|---|---|
Schädler | 2017 | RCT, open-label, multi-centre | Severe sepsis or septic shock and ARDS | 6 h per day for up to 7 consecutive days | 47/50 | 66/65 | 74/70 |
Hawchar | 2019 | RCT, open-label, single-centre | Early (< 24 h) onset of septic shock, mechanical ventilation, norepinephrine > 10 μg/min | 1 treatment for 24 h | 10/10 | 60/71 | 70/60 |
Brouwer | 2019 | Retrospective PS weighted register study, single-centre | Septic shock with CRRT treated on ICU | Treatment until improvement | 67/49 | 61/69 | 55/61 |
Akil | 2020 | Retrospective control group, prospective intervention group, single-centre | Pneumogenic sepsis and ECMO therapy | ≥ 2 treatments; device changed every 24 h | 13/7 | 61/61 | 38/29 |
Schittek | 2020 | Retrospective control group, prospective intervention group, single-centre | Septic shock with acute kidney injury and noradrenaline dose (> 20 µg/min) | ≥ 1 treatment | 43/33 | 63/62 | 88/72 |
Rugg | 2020 | Retrospective PS matched study, single-centre | Septic shock patients with RRT | ≥ 1 treatment | 42/42 | 64/68 | 64/60 |
Kogelmann | 2021 | Retrospective register study, multi-centre | Septic shock patients treated on ICU | ≥ 1 treatment | 198/69 | 62/66 | 61/NA |
Garcia | 2021 | Retrospective control group, prospective intervention group, PS matched study, single-centre | severe, refractory septic shock | 3 treatments for 24 h | 48/48 | 57/58 | 65/65 |
Bernardi | 2016 | RCT, blinded, single-centre | Elective CPB surgery | Treatment during CPB | 19/18 | 64/69 | 63/78 |
Träger | 2017 | Retrospective register study, single-centre | CPB surgery due to acute infective endocarditis | Treatment during CPB | 39/28 | 61/72 | 69/71 |
Nemeth | 2018 | Prospective PS matched study, open-label, single-centre | Orthotopic heart transplantations without early postoperative death (72 h) | Treatment during CPB | 16/16 | 51/50 | 88/78 |
Poli | 2019 | RCT, double-blinded, single-centre | Elective cardiac surgery with expected long CPB duration (> 120 min) | Treatment during CPB | 15/15 | 67/69 | 88/73 |
Gleason | 2019 | RCT, open-label, multi-centre | Complex cardiac surgery with expected CPB duration > 3 h | 2 parallel devices during CPB | 23/23 | 66/61 | 56/78 |
Hassan | 2019 | Retrospective register study, single-centre | Emergency cardiac surgery under ticagrelor or rivaroxaban | Treatment during CPB | 39/16 | NA/ NA | 66/81 |
Saller | 2019 | Retrospective PS matched study, single-centre | Aortic surgery with hypothermic circulatory arrest | Treatment during CPB | 168/168 | 64/63 | 67/67 |
Wagner | 2019 | RCT, blinded, single-centre | Ross or David surgery | Treatment during CPB | 13/10 | 50/54 | 87/100 |
Stupica | 2020 | RCT, double-blinded, single-centre | Elective high risk cardiac surgery with CPB duration > 90 min | Treatment during CPB | 20/20 | 71/71 | 70/70 |
Haidari | 2020 | Retrospective register study, single-centre | Surgery of native mitral valve endocarditis | Treatment during CPB | 30/28 | 59/61 | 70/57 |
Santer | 2021 | Retrospective PS weighted register study, single-centre | Valve surgery due to endocarditis | Treatment during CPB | 41/200 | 66/65 | 92/78 |
Zhigalov | 2021 | Retrospective PS matched study, single-centre | LVAD implantation | Treatment during CPB | 72/40 | 56/58 | 85/77 |
Asch | 2021 | RCT, open-label, single-centre | Cardiac surgery due to infective endocarditis | Treatment during CPB and 3 afterwards for 8 h each | 10/10 | 65/69 | 70/90 |
Hassan | 2022 | Retrospective register study, single-centre | Emergency surgery for acute type A dissection under rivaroxaban or ticagrelor | treatment during CPB | 10/11 | 75/62 | 40/55 |
Diab | 2022 | RCT, open-label, multi-centre | Surgery due to infective endocarditis | Treatment during CPB | 138/144 | 69/69 | 71/77 |
Wilhelmi | 2018 | Retrospective register study, single-centre | Polytrauma | ≥ 1 treatment for up to 4 days | 5/5 | 35/32 | 100/100 |
Rieder | 2021 | Retrospective PS matched study, single-centre | ARDS treated with V-V ECMO and PCT > 3 ng/ml, IL-6 > 600 pg/ml | ≥ 3 treatments | 9/9 | 43/44 | 78/67 |
Scharf | 2021 | Retrospective PS matched study, single-centre | Serve illness (IL-6 > 10,000 pg/ml) | Treatment for at least 90 min | 19/19 | 56/61 | 74/56 |
Rasch | 2022 | Retrospective control group, prospective intervention group, PS matched study, multi-centre | Acute pancreatitis, APACHE-II score of ≥ 10 and ≥ 1 marker of poor prognosis | 2 treatments for 24 h each | 16/32 | 52/60 | 75/66 |
Rampino | 2020 | Retrospective register study, single-centre | COVID-19, PaO2/FiO2 < 200 mmHg, CRP > 10 mg/dL, lymphocyte < 1500/mmc | 2 treatments for 4 h each on 2 consecutive days | 5/4 | 58/66 | 100/75 |
Schroeder | 2020 | Retrospective register study, single-centre | COVID-19 on ICU | ≥ 1 treatment | 13/57 | NA/NA | NA/NA |
Supady | 2021 | RCT, open-label, single-centre | COVID-19 pneumonia requiring ECMO | 3 treatments for 24 h each | 17/17 | 62/59 | 71/76 |
Stockmann | 2022 | RCT, open-label, single-centre | COVID-19 with vasoplegic shock (norepinephrine > 0.2 μg/kg/min, CRP 100 mg/L, and RRT) | ≥ 3 treatments for 24 h each | 23/26 | 61/66 | 91/77 |
Akin | 2020 | Prospective PS matched study, single-centre | Out-of-hospital cardiac arrest with increased vasopressor need | ≥ 1 treatment for up to 3 days | 24/48 | 62/61 | 83/83 |
Supady | 2022 (a) | Retrospective PS matched study, single-centre | After cardiac arrest on ECMO | 3 treatments for 24 h each | 23/23 | 53/53 | 78/74 |
Supady | 2022 (b) | RCT, open-label, single-centre | After cardiac arrest on ECMO | 3 treatments for 24 h each | 22/19 | 61/64 | 68/63 |
Mortality
Trail sequential analysis
ICU and hospital length of stay
Hospital length of stay | ICU length of stay | |||
---|---|---|---|---|
M ± SD | Md [IQR] | M ± SD | Md [IQR] | |
Sepsis | 3.43 (± 10.94) | 0.51 [− 6.19; 7.21] | − 0.99 (± 3.32) | − 0.50 [− 3.19; 2.19] |
CPB surgery | − 1.10 (± 2.89) | − 1.10 [− 4.06; 1.86] | 0.38 (± 1.26) | 0.27 [− 1.01; 1.55] |
Severe illness | ||||
SARS-CoV-2 | ||||
Cardiac arrest | ||||
All studies | − 0.71 (± 2.75) | − 0.87 [− 3.64; 1.91] | 0.29 (± 1.13) | 0.30 [− 0.84; 1.44] |
Norepinephrine and mean arterial pressure (MAP)
Norepinephrine (µg/kg/min) before treatment | Norepinephrine (µg/kg/min) after treatment | MAP (mmHg) before treatment | MAP (mmHg) 24 h after treatment | |||||
---|---|---|---|---|---|---|---|---|
M ± SD | Md [IQR] | M ± SD | Md [IQR] | M ± SD | Md [IQR] | M ± SD | Md [IQR] | |
Sepsis | 0.03 (± 0.25) | 0.05 [− 0.21; 0.31] | 0.00 (± 0.15) | 0.02 [− 0.11; 0.14] | 2.07 (± 9.31) | 1.81 [− 7.18; 10.80] | ||
CPB surgery | 0.01 (± 0.01) | 0.01 [− 0.01; 0.02] | 1.64 (± 2.79) | 2.44 [− 0.61; 5.49] | ||||
Severe illness | ||||||||
SARS-CoV-2 | − 0.03 (± 0.07) | − 0.02 [− 0.06; 0.02] | − 0.01 (± 0.04) | − 0.04 [− 0.10; 0.03] | ||||
Cardiac arrest | − 0.16 (± 0.15) | − 0.09 [− 0.35; 0.18] | ||||||
All studies | − 0.02 (± 0.06) | − 0.02 [− 0.08; 0.04] | 0.00 (± 0.02) | − 0.01 [− 0.02; 0.01] | 1.51 (± 5.61) | 1.12 [− 4.73; 6.97] | 1.17 (± 2.65) | 1.80 [− 1.07; 4.66] |