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

AIM: To investigate the effect of cytokine adsorption in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) after cardiac arrest. - METHODS: CYTER was a single-centre, open-label, randomised, controlled trial. Patients selected for ECPR at the University Medical Center Freiburg (...

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Main Authors: Supady, Alexander (Author) , Zahn, Timm (Author) , Kuhl, Moritz (Author) , Maier, Sven (Author) , Benk, Christoph (Author) , Kaier, Klaus (Author) , Böttiger, Bernd W. (Author) , Bode, Christoph (Author) , Lother, Achim (Author) , Staudacher, Dawid L. (Author) , Wengenmayer, Tobias (Author) , Duerschmied, Daniel (Author)
Format: Article (Journal)
Language:English
Published: 7 February 2022
In: Resuscitation
Year: 2022, Volume: 173, Pages: 169-178
ISSN:1873-1570
DOI:10.1016/j.resuscitation.2022.02.001
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.resuscitation.2022.02.001
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Author Notes:Alexander Supady, Timm Zahn, Moritz Kuhl, Sven Maier, Christoph Benk, Klaus Kaier, Bernd W. Böttiger, Christoph Bode, Achim Lother, Dawid L. Staudacher, Tobias Wengenmayer, Daniel Duerschmied
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Summary:AIM: To investigate the effect of cytokine adsorption in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) after cardiac arrest. - METHODS: 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. - RESULTS: 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. - CONCLUSION: 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. - CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT03685383.
Item Description:Gesehen am 04.08.2022
Physical Description:Online Resource
ISSN:1873-1570
DOI:10.1016/j.resuscitation.2022.02.001

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