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Current Trends in Hemoadsorption Therapy
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Current Trends in Hemoadsorption Therapy

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (25 May 2023) | Viewed by 12509

Special Issue Editor

Prof. Dr. Daniel Wendt

E-Mail Website
Guest Editor
Universitäts Klinikum Essen und Medizinische Fakultät, Essen, Germany
Interests: heart and lung transplantation; aortic valve surgery/experimental; biofluiddynamics/flow simulation; minimal invasive (video-assisted) valve surgery; endovascular aortic therapy; transcatheter heart valve implantation (aortic, mitral)
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue of the Journal of Clinical Medicine focuses on current trends in hemoadsorption therapy.

It is a real pleasure to be the guest editor of this Special Issue of the Journal of Clinical Medicine. Extracorporeal blood purification techniques have gained recent attention in various fields of clinical medicine, and these new and innovative devices can be safely and easily integrated in various extracorporeal circuits (heart–lung machine, ECMO or dialysis) and were capable of removing low-molecular-weight substances from blood by adsorption. Hemoadsorption is currently being applied in various indications in cardiac surgery, nephrology, intensive-care medicine, anesthesiology, transplantation or gastroenterology.  Hemoadsorption has the ability to modulate the immune response by attenuating the so-called “cytokine storm” and therefore has significant potential in the treatment of COVID-19 patients.  Moreover, hemoadsorption can be effectively used in treating severe sepsis, hyperbilirubinemia, endocarditis or high-risk cardiac surgery patients.  Additionally, in drug removal, mainly antithrombotic drugs, such as Ticagrelor or NOACs, hemoadorption will be the future game-changer. 

Therefore, the present Special Issue aims to provide the readers with an update of the current use of hemoadsorption technologies in various fields of clinical medicine. 

Prof. Dr. Daniel Wendt
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Hemoadsorption in drug removal
  • Hemoadsorption in cardiac surgery
  • Hemoadsorption in intensive-care medicine
  • Hemoadsorption in the field of COVID-19
  • Hemoadsorption in gastroenterology
  • Hemoadsorption in transplantation medicine
  • Hemoadsorption in nephrology
  • Extracorporeal techniques in hemoadsorption therapy
  • New scoring algorithms
  • Hemoadsorption in sepsis

Published Papers (6 papers)

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Research

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10 pages, 733 KiB  
Article
Intraoperative Hemoadsorption (Cytosorb™) during Open Thoracoabdominal Aortic Repair: A Pilot Randomized Controlled Trial
by Panagiotis Doukas, Gabriel Hellfritsch, Daniel Wendt, Mirko Magliani, Mohammad E. Barbati, Houman Jalaie, Michael J. Jacobs and Alexander Gombert
J. Clin. Med. 2023, 12(2), 546; https://doi.org/10.3390/jcm12020546 - 09 Jan 2023
Cited by 5 | Viewed by 1566
Abstract
Background: The efficacy of cytokine adsorption in controlling the early inflammation cascade after open thoracoabdominal aortic (TAAA) repair has not been investigated. The aim of this pilot randomized controlled trial was to assess the feasibility and effect of perioperative hemoadsorption during open TAAA [...] Read more.
Background: The efficacy of cytokine adsorption in controlling the early inflammation cascade after open thoracoabdominal aortic (TAAA) repair has not been investigated. The aim of this pilot randomized controlled trial was to assess the feasibility and effect of perioperative hemoadsorption during open TAAA repair. Methods: Patients scheduled for open TAAA repair with the use of cardiopulmonary bypass (CPB) were included. The patients were randomized the day before surgery to either intraoperative hemoadsorption during CPB or standard of care. Results: A total of 10 patients were randomly assigned to the intervention group, whereas the control group consisted of 17 patients (mean age of the total cohort, 51.1 ± 11.2 years, 67% male, 3 patients not randomized). The majority of baseline and perioperative characteristics were similar, and no device-related adverse events were reported. A trend to shorter ventilation times in the intervention group was observed (median 88 h vs. 510 h, p = 0.08, Δ422). Severe acute respiratory distress syndrome was significantly less in the intervention patients (p = 0.02). Conclusions: This is the first pilot study showing that the intraoperative use of hemoadsorption in open TAAA repair patients may be feasible and safe, yet larger trials are needed to evaluate whether intraoperative hemoadsorption is associated with improved clinical outcomes. Full article
(This article belongs to the Special Issue Current Trends in Hemoadsorption Therapy)
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8 pages, 818 KiB  
Article
Hemoadsorption in Complex Cardiac Surgery—A Single Center Experience
by Murali Manohar, Vivek Jawali, Siddu Neginahal, Sudarshan GT, Geetha Muniraj and Murali Chakravarthy
J. Clin. Med. 2022, 11(23), 7005; https://doi.org/10.3390/jcm11237005 - 27 Nov 2022
Cited by 2 | Viewed by 1196
Abstract
(1) Background: Cardiac surgery may evoke a generalized inflammatory response, typically magnified in complex, combined, redo, and emergency procedures with long aortic cross-clamp times. Various treatment options have been introduced to help regain control over post-cardiac surgery hyper-inflammation, including hemoadsorptive immunomodulation with CytoSorb [...] Read more.
(1) Background: Cardiac surgery may evoke a generalized inflammatory response, typically magnified in complex, combined, redo, and emergency procedures with long aortic cross-clamp times. Various treatment options have been introduced to help regain control over post-cardiac surgery hyper-inflammation, including hemoadsorptive immunomodulation with CytoSorb®. (2) Methods: We conducted a single-center retrospective observational study of patients undergoing complex cardiac surgery. Patients intra-operatively treated with CytoSorb® were compared to a control group. The primary outcome was the change in the vasoactive-inotropic score (VIS) from pre-operatively to post-operatively. (3) Results: A total of 52 patients were included in the analysis, where 23 were treated with CytoSorb® (CS) and 29 without (controls). The mean VIS increase from pre-operative to post-operative values was significantly lower in the CS group compared to the control group (3.5 vs. 5.5, respectively, p = 0.05). In-hospital mortality in the control group was 20.7% (6 patients) and 9.1% (2 patients) in the CS group (p = 0.26). Lactate level changes were comparable, and the median intensive care unit and hospital lengths of stay were similar between groups. (4) Conclusions: Despite notable imbalances between the groups, the signals revealed point toward better hemodynamic stability with CytoSorb® hemoadsorption in complex cardiac surgery and a trend of lower mortality. Full article
(This article belongs to the Special Issue Current Trends in Hemoadsorption Therapy)
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8 pages, 1317 KiB  
Article
Pumpless Extracorporeal Hemadsorption Technique (pEHAT): A Proof-of-Concept Animal Study
by Mascha O. Fiedler, Ralf M. Muellenbach, Caroline Rolfes, Christopher Lotz, Felix Nickel, Beat P. Müller-Stich, Alexander Supady, Philipp M. Lepper, Markus A. Weigand, Patrick Meybohm, Armin Kalenka and Christian Reyher
J. Clin. Med. 2022, 11(22), 6815; https://doi.org/10.3390/jcm11226815 - 18 Nov 2022
Cited by 1 | Viewed by 1527
Abstract
Background: Extracorporeal hemadsorption eliminates proinflammatory mediators in critically ill patients with hyperinflammation. The use of a pumpless extracorporeal hemadsorption technique allows its early usage prior to organ failure and the need for an additional medical device. In our animal model, we investigated [...] Read more.
Background: Extracorporeal hemadsorption eliminates proinflammatory mediators in critically ill patients with hyperinflammation. The use of a pumpless extracorporeal hemadsorption technique allows its early usage prior to organ failure and the need for an additional medical device. In our animal model, we investigated the feasibility of pumpless extracorporeal hemadsorption over a wide range of mean arterial pressures (MAP). Methods: An arteriovenous shunt between the femoral artery and femoral vein was established in eight pigs. The hemadsorption devices were inserted into the shunt circulation; four pigs received CytoSorb® and four Oxiris® hemadsorbers. Extracorporeal blood flow was measured in a range between mean arterial pressures of 45–85 mmHg. Mean arterial pressures were preset using intravenous infusions of noradrenaline, urapidil, or increased sedatives. Results: Extracorporeal blood flows remained well above the minimum flows recommended by the manufacturers throughout all MAP steps for both devices. Linear regression resulted in CytoSorb® blood flow [mL/min] = 4.226 × MAP [mmHg] − 3.496 (R-square 0.8133) and Oxiris® blood flow [mL/min] = 3.267 × MAP [mmHg] + 57.63 (R-square 0.8708), respectively. Conclusion: Arteriovenous pumpless extracorporeal hemadsorption resulted in sufficient blood flows through both the CytoSorb® and Oxiris® devices over a wide range of mean arterial blood pressures and is likely an intriguing therapeutic option in the early phase of septic shock or hyperinflammatory syndromes. Full article
(This article belongs to the Special Issue Current Trends in Hemoadsorption Therapy)
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13 pages, 1706 KiB  
Article
Influence of Venoarterial Extracorporeal Membrane Oxygenation Integrated Hemoadsorption on the Early Reversal of Multiorgan and Microcirculatory Dysfunction and Outcome of Refractory Cardiogenic Shock
by Adam Soltesz, Zsofia Anna Molnar, Zsofia Szakal-Toth, Eszter Tamaska, Hajna Katona, Szabolcs Fabry, Gergely Csikos, Viktor Berzsenyi, Csilla Tamas, Istvan Ferenc Edes, Janos Gal, Bela Merkely and Endre Nemeth
J. Clin. Med. 2022, 11(21), 6517; https://doi.org/10.3390/jcm11216517 - 02 Nov 2022
Cited by 7 | Viewed by 1891
Abstract
Background: The purpose of this investigation was to evaluate the impact of venoarterial extracorporeal membrane oxygenation (VA–ECMO) integrated hemoadsorption on the reversal of multiorgan and microcirculatory dysfunction, and early mortality of refractory cardiogenic shock patients. Methods: Propensity score–matched cohort study of 29 pairs [...] Read more.
Background: The purpose of this investigation was to evaluate the impact of venoarterial extracorporeal membrane oxygenation (VA–ECMO) integrated hemoadsorption on the reversal of multiorgan and microcirculatory dysfunction, and early mortality of refractory cardiogenic shock patients. Methods: Propensity score–matched cohort study of 29 pairs of patients. Subjects received either VA–ECMO supplemented with hemoadsorption or standard VA–ECMO management. Results: There was a lower mean sequential organ failure assessment score (p = 0.04), lactate concentration (p = 0.015), P(v–a)CO2 gap (p < 0.001), vasoactive inotropic score (p = 0.007), and reduced delta C–reactive protein level (p = 0.005) in the hemoadsorption compared to control groups after 72 h. In–hospital mortality was similar to the predictions in the control group (62.1%) and was much lower than the predicted value in the hemoadsorption group (44.8%). There were less ECMO-associated bleeding complications in the hemoadsorption group compared to controls (p = 0.049). Overall, 90-day survival was better in the hemoadsorption group than in controls without statistical significance. Conclusion: VA–ECMO integrated hemoadsorption treatment was associated with accelerated recovery of multiorgan and microcirculatory dysfunction, mitigated inflammatory response, less bleeding complications, and lower risk for early mortality in comparison with controls. Full article
(This article belongs to the Special Issue Current Trends in Hemoadsorption Therapy)
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Review

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16 pages, 2330 KiB  
Review
Use of CytoSorb© Hemoadsorption in Patients on Veno-Venous ECMO Support for Severe Acute Respiratory Distress Syndrome: A Systematic Review
by Ali Akil, L. Christian Napp, Cristina Rao, Teresa Klaus, Joerg Scheier and Federico Pappalardo
J. Clin. Med. 2022, 11(20), 5990; https://doi.org/10.3390/jcm11205990 - 11 Oct 2022
Cited by 6 | Viewed by 2418
Abstract
Acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality. Adjunct hemoadsorption is increasingly utilized to target underlying hyperinflammation derived from ARDS. This article aims to review available data on the use of CytoSorb© therapy in combination with V-V ECMO in [...] Read more.
Acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality. Adjunct hemoadsorption is increasingly utilized to target underlying hyperinflammation derived from ARDS. This article aims to review available data on the use of CytoSorb© therapy in combination with V-V ECMO in severe ARDS, and to assess the effects on inflammatory, laboratory and clinical parameters, as well as on patient outcomes. A systematic literature review was conducted and reported in compliance with principles derived from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. When applicable, a before-and-after analysis for relevant biomarkers and clinical parameters was carried out. CytoSorb© use was associated with significant reductions in circulating levels of C-reactive protein and interleukin-6 (p = 0.039 and p = 0.049, respectively). Increases in PaO2/FiO2 reached significance as well (p = 0.028), while norepinephrine dosage reductions showed a non-significant trend (p = 0.067). Mortality rates in CytoSorb© patients tended to be lower than those of control groups of most included studies, which, however, were characterized by high heterogeneity and low power. In an exploratory analysis on 90-day mortality in COVID-19 patients supported with V-V ECMO, the therapy was associated with a significantly reduced risk of death. Based on the reviewed data, CytoSorb© therapy is able to reduce inflammation and potentially improves survival in ARDS patients treated with V-V ECMO. Early initiation of CytoSorb© in conjunction with ECMO might offer a new approach to enhance lung rest and promote recovery in patients with severe ARDS. Full article
(This article belongs to the Special Issue Current Trends in Hemoadsorption Therapy)
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19 pages, 1204 KiB  
Review
Sepsis Management in Southeast Asia: A Review and Clinical Experience
by Yatin Mehta, Rajib Paul, Raihan Rabbani, Subhash Prasad Acharya and Ushira Kapilani Withanaarachchi
J. Clin. Med. 2022, 11(13), 3635; https://doi.org/10.3390/jcm11133635 - 23 Jun 2022
Cited by 6 | Viewed by 2865
Abstract
Sepsis is a life-threatening condition that causes a global health burden associated with high mortality and morbidity. Often life-threatening, sepsis can be caused by bacteria, viruses, parasites or fungi. Sepsis management primarily focuses on source control and early broad-spectrum antibiotics, plus organ function [...] Read more.
Sepsis is a life-threatening condition that causes a global health burden associated with high mortality and morbidity. Often life-threatening, sepsis can be caused by bacteria, viruses, parasites or fungi. Sepsis management primarily focuses on source control and early broad-spectrum antibiotics, plus organ function support. Comprehensive changes in the way we manage sepsis patients include early identification, infective focus identification and immediate treatment with antimicrobial therapy, appropriate supportive care and hemodynamic optimization. Despite all efforts of clinical and experimental research over thirty years, the capacity to positively influence the outcome of the disease remains limited. This can be due to limited studies available on sepsis in developing countries, especially in Southeast Asia. This review summarizes the progress made in the diagnosis and time associated with sepsis, colistin resistance and chloramphenicol boon, antibiotic abuse, resource constraints and association of sepsis with COVID-19 in Southeast Asia. A personalized approach and innovative therapeutic alternatives such as CytoSorb® are highlighted as potential options for the treatment of patients with sepsis in Southeast Asia. Full article
(This article belongs to the Special Issue Current Trends in Hemoadsorption Therapy)
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