Extracorporeal Cytokine Adsorption Therapy As a Preventive Measure in Cardiac Surgery and As a Therapeutic Add-On Treatment in Sepsis: An Updated Systematic Review of Comparative Efficacy and Safety*
- 1 August 2021
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 49 (8), 1347-1357
- https://doi.org/10.1097/CCM.0000000000005023
Abstract
OBJECTIVES: Evaluating whether there is a clinical benefit of using extracorporeal cytokine adsorption therapy in two indications. DESIGN: Systematic review. SETTING: Search on four databases, Medline, Embase, The Cochrane Library, and the European Network for Health Technology Assessment planned and ongoing projects database. PATIENTS: Patients with sepsis/septic shock; patients undergoing cardiac surgery INTERVENTIONS: Cytokine adsorption. MEASUREMENTS AND MAIN RESULTS: Randomized controlled trials and prospective studies with concurrent control were eligible for the evidence synthesis. The quality of the individual studies and the strength of the available evidence were assessed using the Cochrane risk of bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation approach, respectively. For the preventive treatment of extracorporeal cytokine adsorption therapy in patients undergoing cardiac surgery, we found very low-quality inconclusive evidence for mortality (five randomized controlled trials, n = 163), length of stay in the ICU (five randomized controlled trials, n = 163), and length of hospitalization (three randomized controlled trials, n = 101). Very low-quality inconclusive evidence was found for (serious) adverse events (four randomized controlled trials, n = 148). For the therapeutic treatment of extracorporeal cytokine adsorption therapy in patients with sepsis/septic shock, we found very low-quality inconclusive evidence for mortality up to 60-day follow-up (two randomized controlled trials, n = 117), organ function (two randomized controlled trials, n = 117) and length of stay in the ICU (one randomized controlled trial, n = 20). Very low-quality inconclusive evidence was found for (serious) adverse events (two randomized controlled trials, n = 117). CONCLUSIONS: Given the available evidence, the efficacy and safety of extracorporeal cytokine adsorption therapy in combination with standard care in the investigated indications was not established. We strongly recommend considering well-powered studies with patient-relevant endpoints instead of investing further research funds on studies that may not shed light on the clinical benefit of extracorporeal cytokine adsorption therapy.Keywords
This publication has 23 references indexed in Scilit:
- Early report: The use of Cytosorb™ haemabsorption column as an adjunct in managing severe sepsis: initial experiences, review and recommendationsJournal of the Intensive Care Society, 2015
- PRE-COVERAGE ASSESSMENTS OF NEW HOSPITAL INTERVENTIONS ON AUSTRIA: METHODOLOGY AND 3 YEARS OF EXPERIENCEInternational Journal of Technology Assessment in Health Care, 2012
- Extracorporeal Therapies in SepsisJournal of Intensive Care Medicine, 2011
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trialsBMJ, 2011
- GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tablesJournal of Clinical Epidemiology, 2011
- The dangers of the fast trackNature Medicine, 2011
- Clinical review: Blood purification for sepsisCritical Care, 2011
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaborationJournal of Clinical Epidemiology, 2009
- Serum Cytokine Levels in Human Septic ShockChest, 1993