LAUSR

Cardiopulmonary bypass (CPB) is inexorably linked to varying degrees of inflammatory response activation, mediated by diverse cytokines. A dysregulated cytokine inflammatory response, or a cytokine storm, results in significant systemic hypotension, culminating as multi-organ failure (MOF). Considering the association of the cytokine surge with adverse postoperative outcomes and heightened morbidity and mortality[1], it has been proposed that the extracorporeal cytokine removal presents the potential of improving the outcomes across heterogeneous clinical scenarios characterized by lethal hyperinflammation. In this context, various blood purification techniques (BPTs) have evolved for the maintenance of an immune homeostasis. These techniques include (but are not limited to): hemofiltration, continuous high-volume hemofiltration, hemoperfusion, plasmapheresis, high cutoff membranes, and adsorption. There is a considerable recent literature on the application of hemoadsorption (HA) therapy in acute inflammatory cytokine release syndrome attributable to sepsis, CPB, and/or autoimmune diseases[2-5]. HA therapy comprises the blood or plasma passage through a cartridge wherein the molecules are removed as a result of binding to the biocompatible sorbent. CytoSorb (CS) (CytoSorbents Corporation, New Jersey, United States of America) is a novel, single-use, polymer bead-based HA cartridge containing polyvinylpyrrolidone coated polystyrene divinylbenzene beads, capable of removing the mid-molecular weight solutes based on the combination of size exclusion and the underlying hydrophobic interactions. It has been approved in Europe since 2011 and can be utilized alone or in combination with renal replacement therapy (RRT), CPB machine, or extracorporeal membrane oxygenation (ECMO). Rohan Magoon1, DM, MD; Manpal Loona2, DNB CTVS; Jasvinder Kaur Kohli1, MD; Ramesh Kashav1, MD Cytokine Adsorption in Cardiac Surgery: where do we stand?