Cytokine adsorption in patients with post-cardiac arrest syndrome after extracorporeal cardiopulmonary resuscitation (CYTER) - A single-centre, open-label, randomised, controlled trial.

To investigate the effect of cytokine adsorption in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) after cardiac arrest. CYTER was a single-centre, open-label, randomised, controlled trial. Patients selected for ECPR at the University Medical Center Freiburg (Freiburg, Germany) were assigned to extracorporeal membrane oxygenation (ECMO) support with or without cytokine adsorption (1:1) using the CytoSorb adsorber, incorporated into the ECMO, replaced every 24 hours, and removed after 72 hours. The primary endpoint was serum interleukin (IL)-6 concentration at 72 hours (intention-to-treat analysis). Secondary endpoints included 30-day survival, vasopressor support and biomarkers of end-organ injury. Of 50 patients enrolled in the trial, 26 (52%) were treated with cytokine adsorption and 24 (48%) without. Nine patients were excluded (informed consent could not be obtained); 41 patients were therefore included in the primary analysis. Median IL-6 levels (IQR) decreased from 408.0(93.4-906.5) to 324.0 (134.3-4617.3) pg/mL and increased from 133.0 (56.2-528.5) to 241.0 (132.8-718.0) pg/mL in the cytokine adsorption and control group, respectively (linear regression for treatment [cytokine adsorption vs control]: p = 0.48). Three (14%) of 22 patients treated with cytokine adsorption and 8 (42%) of 19 patients treated without cytokine adsorption survived to day 30 (HR = 1.85, 95% CI 0.86-4.01; p = 0.10). Vasopressor support and NSE, S100b, troponin T, CRP and PCT levels were similar between groups. Cytokine adsorption in patients receiving ECPR did not reduce serum IL-6 and had no significant effect on survival, vasopressor support, or biomarkers of injury. ClinicalTrials.gov: NCT03685383.

Informations de copyright

Copyright © 2022 Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest All authors have completed the ICMJE form (available upon request from the corresponding author). AS reports research grants and lecture fees from CytoSorbents and lecture fees from Abiomed, both outside the submitted work. AL reports a research grant from the German Center for Infectious diseases, outside the submitted work. SM reports honoraria from CytoSorbents for a presentation during a scientific workshop. CBe is a shareholder of Resuscitec GmbH, received personal fees from Resuscitec GmbH, and holds patents US 10695407 and EU 3016675 issued to Resuscitec GmbH. CBe reports lecture honoraria from CytoSorbents. BB is treasurer of the European Resuscitation Council (ERC), chairman of the German Resuscitation Council (GRC), member of the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR), member of the Executive Committee of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), founder of the German Foundation for Resuscitation, co-editor of Resuscitation, editor of the journal Notfall + Rettungsmedizin, and co-editor of the Brazilian Journal of Anesthesiology; BB received fees for lectures from the following companies: Forum für medizinische Fortbildung - FomF GmbH, Baxalta Deutschland GmbH, ZOLL Medical Deutschland GmbH, C.R. Bard GmbH, GS Elektromedizinische Geräte G. Stemple GmbH, Novartis Pharma GmbH, Philips GmbH Market DACH, and Bioscience Valuation BSV GmbH. DS reports lecture fees from Orion Pharma, Abiomed, Getinge Group, AstraZeneca, Medcaptain, and Medtronic, travel support for the attendance of scientific meetings from Orion Pharma and Abiomed, and fees from Orion Pharma for medical writing work. DD reports research grants, lecture fees, and travel support from CytoSorbents, all outside the submitted work. The other co-authors report no conflicts of interest.