LAUSR

Background Several extracorporeal blood purification techniques have been proposed in critically ill patients with sepsis and sepsis-like syndromes. Despite theoretical benefits, recent Surviving Sepsis Campaign guidelines have not formulated a recommendation in favour of or against such techniques and urged for further research [1]. In this context, CytoSorb® (CytoSorbents Corporation, NJ, USA) was recently licensed for extracorporeal cytokine removal within the European Union (EU). Cytosorb® cartridges contain biocompatible polystyrene divinylbenzene copolymer beads capable of adsorbing molecules of medium molecular weight using a combination of size exclusion and hydrophobic interactions [2]. They can be used in stand-alone mode (hemoperfusion) or inserted within a continuous renal replacement therapy (CRRT) circuit (associated with a conventional hemofilter), a cardiopulmonary bypass (CPB) or an extracorporeal membrane oxygenation circuit. CytoSorb® (Fig. 1) removes a wide range of molecules from the blood: proand anti-inflammatory cytokines, bilirubin, myoglobin, exotoxins, but also drugs [2–4]. Cytosorb® is currently marketed in 53 countries worldwide. Its utilization has considerably expanded over recent years, with 211 centres currently participating in an international CytoSorb® registry. However, if unselective blood purification could be beneficial through removal of “bad humours”, it could equally be deleterious through the removal of other important molecules. In addition, CytoSorb® cartridges are costly and require therapeutic anticoagulation. Therefore, high-quality evidence must be obtained before widespread utilization of the device can be recommended. This article reviews the existing evidence related to Cytosorb® utilization in various clinical situations.