Protect your cardiovascular patients
Complex cardiac surgeries with use of CPB can result in a dysregulated immune response with clinical complications like vasoplegic shock and multi-organ dysfunction syndrome. Emergency cardiac surgeries in patients on antithrombotic drugs such as ticagrelor or rivaroxaban can result in severe bleeding complications.
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Intraoperative
The use of CytoSorb® during surgery is intended to prevent postoperative hyperinflammation and its complications, or to remove ticagrelor and rivaroxaban in order to reduce the bleeding risk.
Re-balancing the immune response and reducing or preventing the related damage is prudent in very complex procedures, such as heart transplantation or aortic surgery, or in cases of infective endocarditis surgery, when the immune system is already activated and there is a high risk for further activation during surgical intervention. Intraoperative use of CytoSorb is then meant to help improve hemodynamic stability and postoperative outcomes.
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Postoperative
In the postoperative setting, our innovative CytoSorb technology works quickly to support shock reversal – a vital, life-saving measure needed to avoid the devastating effects of ongoing systemic hyperinflammation causing severe hemodynamic instability, eventually resulting in multi-organ failure.
CytoSorb can be applied in various cardiovascular indications
Safeguard urgent surgeries against bleeding risks
Interoperative use of CytoSorb swiftly removes antithrombotic agents, reducing bleeding complications in urgent surgeries and enhancing patient safety.
Master bleeding risks
In case of urgent or emergency surgery with no time to wait, antithrombotics can lead to an increase in perioperative bleeding. CytoSorb has been shown to be safe and effective for intraoperative antithrombotic drug removal.
When it comes to cardiac surgery, the underlying pathology, the complexity of the surgical procedures, and the urgent or emergent need for surgery mean there is an inherently higher risk of perioperative bleeding. The use of DOACs like e.g. rivaroxaban and the anti-platelet agent ticagrelor pose an even higher additional risk of bleeding if drug washout is not possible.
By removal of ticagrelor and rivaroxaban during cardiopulmonary bypass surgery, CytoSorb has been shown to support faster patient recovery by reducting perioperative bleeding:
Reduced operation time
Reduced RBC transfusion
Reduced PLT transfusion
Reduced re-thoracotomy rates
Reduced ICU length of stay
Reduced drainage volume
Drainage volume
CytoSorb® provides significant reduction in drainage volume
The 24-hours drainage volume was significantly lower in adsorber-treated patients; patients on with ticagrelor and rivaroxaban and with (right side) and without (left side) hemadsorption.
Hassan K et al., Ann Thorac Cardiovasc Surg. 2022 28(3):186-192
Cost effectiveness
CytoSorb Therapy provides significant cost savings over standard of care across several healthcare systems (1-2)
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Healthcare system
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| Overall cost saving vs Standard of care | £3,941 (1) | €4,200 ± 1,100 (2) |
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- Javanbakht et al., Pharmacoecon Open 2020; 4(2):307-319
- Hassan et al., Presented at ESC Congress, Barcelona Spain, August 2022: 1279
Best practice therapy management
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Therapeutic goal
Reduction of bleeding complications, blood product use, and length of ICU stay
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Patient selection
Patients undergoing cardiac surgery who were pretreated with ticagrelor and / or rivaroxaban, with last dose of Ticagrelor < 72 hrs. and Rivaroxaban < 48 hrs.
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Timing
Start therapy with the start of CPB. CytoSorb® is easily integrated into the CPB circuit (post-pump to venous reservoir)
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Dosing
Postoperative continuation (with a new adsorber integrated into an extracorporeal circuit) is normally NOT needed if CPB time > 60 min, but can be done if needed.
Protect your surgical outcomes
Major surgery with CPB poses the risk of postoperative complications related to hyperinflammation. Intraoperative use of CytoSorb is intended to remove excessive levels of cytokines, thereby preventing these complications.
Stabilize your infective-endocarditis patients
Despite being a curative therapeutic approach, infective-endocarditis surgery carries the risk of bacterial spread and further activation of the immune system, resulting in severe hemodynamic instability and further complications like multi-organ failure.
CytoSorb has been shown to effectively and safely reduce elevated levels of cytokines in infective-endocarditis patients.
By removal of elevated cytokines, CytoSorb Therapy can help to safely manage infective endocarditis patients through reduction in perioperative bleeding:
Promotion of hemodynamic stability
Reduction in length of ICU stays
Reduction in vasopressors needs
Reduction in sepsis and sepsis-related mortality
Reduction in mortality in patients infected with Staphylococcus aureus
Infective Endocarditis
Treatment Rationale & Guidance
Improve your surgical outcomes. Remove excessive cytokines and PAMPs/DAMPs. Eliminate toxins and hemolysins. Prevent and reverse systemic inflammation. Stabilize micro- and macro-hemodynamics. Preserve and restore organ function.
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Reduce endothelial damaging proteins / toxins and hemolysins
Kalisnik et al.Removes excessive cytokines and inflammatory mediators/DAMPs etc
In cases of “hot” endocarditis, when patients show full blown inflammation signs, fever and positive blood cultures, cardiac surgery faces the challenge of intra-and postoperative hemodynamic instability. Based on the systemic inflammation status and peri-operative burden, mortality in these high-risk patients is high.
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Improve capillary leakage / Reduce pathogenicity (e.g. S. aureus)
Piskovatska et al.Removes endothelial damaging proteins / toxins and hemolysins
A major problem in systemic inflammatory diseases is the “leaky bucket” phenomenon at the tissue level: the endothelial firewall is disrupted, resulting in fluid loss into the interstitium and subsequent tissue edema. Circulating cytokines and certain proteins drive this process by damaging endothelial tight junctions.
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Stabilize micro- and macro-circulation
Holmen et al.Supports Hemodynamic stabilization > Vasopressor Reduction
Based on the problem of capillary leakage, micro- and later macrocirculatory problems arise, leading to impaired tissue perfusion and oxygenation, as well as extensive need for supportive vasopressor medications. Mastering these crises of micro- and microcirculatory stability is essential for patient recovery.
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Avoid SoC side and post-op effects
Haidari et al.Keeps immune response in balance
With a balanced level of cytokines and DAMPS/PAMPS, less postoperative need for vasopressors and fluid support could be achieved, resulting in improved mortality outcomes.
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Preserve and restore organ function
Rao et al.Reduces sepsis / infection-associated mortality > faster recovery > shorter ICU stay > cost savings
The improved intra- and post-operative condition supports faster recovery from the stressful surgery, enhances the effects of concomitant SoC treatments, and allows for shorter ICU stays with corresponding cost benefits.
Protect aortic surgery patients
Complex cardiac surgeries like aortic surgery can result in a dysregulated immune response with clinical complications such as vasoplegic shock or multi-organ failure.
CytoSorb has been shown to reduce elevated levels of cytokines to promote hemodynamic stability and protect aortic surgery patients from hyperinflammation risk.
CytoSorb Therapy can help to:
Attenuate hyperinflammation
Improve pulmonary function
Promote hemodynamic stability
Reduce blood product use
Reduce vasopressor needs
Aortic surgery
Treatment Rationale & Guidance
Protect your aortic surgery patient. Remove excessive cytokines and DAMPs. Manage additional bleeding risk through removal of antithrombotics. Stabilize micro- and macro-hemodynamics. Preserve and restore organ function.
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Protect your Aortic Surgery patient
Jansen et al.Reduces inflammatory mediators, PAMPs
Complex aortic surgery is often characterised by long periods of cardiopulmonary bypass, resulting in hyperinflammation. Providing the best conditions and setting for effective surgery and rapid patient recovery is therefore a key objective and challenge for the OR staff.
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Control bleeding risk, reduce inflammatory response
Undlien et al.Removes blood thinner, reduces impact of DAMPs and attenuates case complexity
In the case of urgent aortic surgery, patients sometimes present on anticoagulants. Avoiding exacerbations due to the need for wash-out time, intraoperative removal of these agents is an advantage of intraoperative HA. In addition, the control of inflammatory expansion by rebalancing its mediators speaks in favour of simple plug-and-play use on CPB pumps.
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Improve capillary leakage
Piskovatska et al.Removes endothelial damaging proteins
A major problem in systemic inflammatory diseases is the “leaky bucket” phenomenon at the tissue level: the endothelial firewall is disrupted, resulting in fluid loss into the interstitium and subsequent tissue edema. Circulating cytokines and certain proteins drive this process by damaging endothelial tight junctions.
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Stabilize micro and macro-circulation/SIRS
Saller et al.Supports Hemodynamic stabilization > allows vasopressor reduction
Based on the problem of capillary leakage, micro- and later macrocirculatory problems arise, leading to impaired tissue perfusion and oxygenation, as well as extensive need for supportive vasopressor medications. Mastering these crises of micro- and macrocirculatory stability is essential for patient recovery.
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Avoid SoC side and post-op effects
Mehta et al.Keeps immune response in balance
Reduced post-operative need for vasopressors, fluid support and blood products could be achieved by balancing levels of inflammatory mediators and removing various blood thinners, resulting in improved clinical recovery.
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Preserve and restore organ function
Doukas et al.Less ARDS, improved lung function. Reduced ICU stay, cost savings.
The improved intra- and post-operative condition supports faster recovery from the stressful surgery, enhances the effects of concomitant SoC treatments, and allows for shorter ICU stays with corresponding cost benefits.
Stabilize your heart failure patients
Heart failure patients carry a high risk of developing cardiogenic shock, which, like other states of hypoperfusion, can trigger the immune system and result in a dysregulated immune response with vasoplegic shock and further severe clinical consequences. Patients undergoing orthotopic heart transplantation are among the highest risk for perioperative vasoplegic syndrome.
CytoSorb has been shown to reduce elevated levels of cytokines to help stabilize heart failure patients.
CytoSorb Therapy can help to:
Promote hemodynamic stability
Reduce the need for postoperative dialysis (heart transplantation)
Reduce the need for postoperative dialysis (heart transplantation)
Vasoactive inotropic score during 24h after heart transplantationMajor components of vasoactive inotropic score during the first 24 h after orthotopic heart transplantation. Noradrenaline (A); Argipressin (B); Dobutamine (C); Milrinone (D). N=55. Data are presented as medians and 95% confidence intervals.
E. Nemeth et al., ESC Heart Failure 2024;11(2):772–782
Reduce vasopressor needs
Control postsurgical hyperinflammation
In a postoperative setting, our innovative CytoSorb technology works quickly to support shock reversal – a vital, life-saving measure needed to avoid the devastating effects of ongoing systemic hyperinflammation causing severe hemodynamic instability, eventually resulting in multi-organ failure.
Stabilize hemodynamics
An uncontrolled inflammatory response after surgery plays a significant role in post-op morbidity or mortality, contributing to vasoplegic shock and multi-organ dysfunction.
CytoSorb has been shown to effectively and safely reduce elevated levels of cytokines to help control postsurgical hyperinflammation and improve hemodynamic stability.
The use of CytoSorb Therapy can help safely manage the risks associated with hyperinflammation, resulting in:
Attenuation of hyperinflammation
Promotion of hemodynamic stability and shock reversal
Noradrenalin and adrenalin requirement
Promotion of hemodynamic stability and shock reversal
Boss K et al., PLoS One 2021; 16(2):e0246299
Improvement of micro- and macro-circulation
Reduction in vasopressors
Noradrenalin and adrenalin requirement
Promotion of hemodynamic stability and shock reversal
Boss K et al., PLoS One 2021; 16(2):e0246299
Best practice therapy management
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Therapy Goal
To stabilize hemodynamics and reduce mortality risk
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Patient selection
- Refractory septic/vasoplegic shock
- High (and increasing) need for vasopressors
- No (proper) response to standard of care
- Biomarkers (if available): IL-6 > 500 pg/mL, PCT > 3 µg/L, ferritin > 1000 µg/L
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Timing
- < 24 hours after diagnosis / start of standard therapy
- Do not wait until lactate is > 6.5 / 7 mmol/L
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Dosing
- Continue until sufficient hemodynamic stabilization is achieved
- Change after 12 hours if instability persists
Support your ECMO patients
ECMO patients have a high risk of concomitant hyperinflammation. Either the underlying disease leading to the need for ECMO is associated with hyperinflammation, or the extracorporeal circuit can trigger it.
ECMO with CytoSorb
ECMO is increasingly used in ARDS and cardiogenic shock, but morbidity and mortality rates remain high.
Treatment options to enhance the clinical benefits of ECMO support and prevent complications, such as ongoing hyperinflammation, are currently limited.
CytoSorb is intended to modulate an accompanying or triggered immune response by removal of elevated levels of cytokines and thus aims to increase the chances of recovery.
Enhance VA-ECMO Outcomes
Venoarterial (VA) ECMO supports the normalization of macro-circulatory hemodynamics and fluid balance, but mechanical circulatory support itself can introduce stress, which negatively impacts on micro-circulatory function. CytoSorb accelerates the stabilization of hemodynamics in VA-ECMO patients, promoting organ recovery.
Support VV-ECMO patients
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Voices around the world
Access Healthcare Professionals Area
This area is for Health Care Professionals only and provides reports about clinical experiences gained during the use of CytoSorbents products. The information presented reflects the opinions and procedural techniques of individual physicians and is not intended as medical advice. Physician experience, risks, patient outcomes and results may vary. This content is intended for Health Care Professionals outside the United States and Canada as CytoSorb has not yet been approved or cleared in the United States or Canada for any indication, except under an Emergency Use Authorization (EUA) by the US FDA.