Supporting control in Critical Care
Whether resulting from infection or from a sterile trigger such as severe injury or major surgery, systemic hyperinflammation with elevated cytokine levels may contribute to hemodynamic instability and organ dysfunction. Use the CytoScore calculator to help assess the patient state and support decisions on when CytoSorb® Therapy may be considered.
The challenge in severe hyperinflammation
The cause
Infections or non-infective triggers such as severe injury or major surgery can induce an excessive immune response.
Immune response
Overwhelming levels of inflammatory mediators may lead to a cytokine storm.
Hemodynamic instability
The cytokine storm is associated with hemodynamic instability and vasoplegic shock, potentially contributing to multi-organ dysfunction.
Restore the balance
CytoSorb® is intended to help manage elevated cytokine levels and support hemodynamic stabilization as part of a multimodal treatment approach — allowing clinicians to focus on providing optimal patient care.
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The cause
Infections or non-infective triggers such as severe injury or major surgery can induce an excessive immune response.
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Immune response
Overwhelming levels of inflammatory mediators may lead to a cytokine storm.
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Hemodynamic instability
The cytokine storm is associated with hemodynamic instability and vasoplegic shock, potentially contributing to multi-organ dysfunction.
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Restore the balance
CytoSorb® is intended to help manage elevated cytokine levels and support hemodynamic stabilization as part of a multimodal treatment approach — allowing clinicians to focus on providing optimal patient care.
CytoSorb can be applied across critical care challenges
Supporting shock recovery to help restore balance
Excessive cytokine release during systemic hyperinflammation can lead to vasoplegia and circulatory shock, posing acute and life-threatening challenges for patients. CytoSorb® is intended to support the management of hyperinflammation and assist in stabilizing hemodynamics.
Stabilize hemodynamics
CytoSorb® utilizes proprietary adsorptive bead technology intended for the reduction of selected inflammatory mediators associated with vasoplegic conditions such as sepsis, and has been reported in clinical experience to be associated with improvements in circulatory parameters.
By adsorption of elevated cytokines, CytoSorb® Therapy may support hemodynamic stability through:
Attenuation of excessive systemic inflammation
Support of capillary integrity
Norepinephrine requirements
In septic-shock patients, following initiation of CytoSorb Therapy, vasopressor needs halved within 24 hours. In the control group, unlike the CytoSorb group, no significant difference can be seen within the first 48 hrs.
Maintenance of micro- and macro-circulation
Facilitation of balanced fluid management
Support of physiological organ function
Hyperinflammatory shock
Treatment goals & Rationale
Break the cycle of systemic inflammation. Prevent and reverse capillary leak. Stabilize micro- and macro-hemodynamics. Enable early active removal of excess fluids. Preserve and restore organ function.
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Break the cycle of systemic inflammation
Jansen et al.Addressing elevated cytokines and inflammatory mediators
Addressing elevated cytokines and inflammatory mediators is central in managing patients prone to refractory vasoplegic shock. Excessive cytokine release represents a major hyperinflammatory mechanism driving a self-amplifying process that may be difficult to control with standard therapy alone.
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Reduce capillary leakage
Papp et al.CytoSorb® targets mediators associated with endothelial activation, aiming to support preservation of endothelial integrity.
In hyperinflammatory shock, the disruption of endothelial tight junctions can result in fluid loss and tissue edema. Circulating cytokines and certain proteins are known to contribute to this process.
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Stabilize micro- and macro-circulation
Hawchar et al.CytoSorb® Therapy is intended to support hemodynamic stabilization and may assist in optimizing vasopressor therapy.
Micro- and macrocirculatory imbalances can impair tissue perfusion and oxygenation, often requiring vasopressor support.
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Reduce fluid balance / Edema
Kogelmann et al.CytoSorb® supports prerequisites for effective fluid management
Once stability is achieved and vascular permeability is controlled, fluid administration can be optimized and excess fluid may be removed via dialysis or diuretics as clinically indicated.
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Preserve organ function
Szigetvary et al.Lung: Improved diffusion distance may facilitate gas exchange.
Kidney: Decompression of the filtration system may support urine flow and balance. Liver: Adsorptive removal of selected toxins is intended to support metabolic and detoxification processes. Rebalancing cytokines and inflammatory mediators through CytoSorb® Therapy is intended to help maintain organ tissue integrity and physiological function during vasoplegic shock conditions.
Support your decision with CytoScore
The CytoScore is a dynamic system intended to support clinical decision-making regarding the potential initiation of CytoSorb® Therapy in refractory septic or vasoplegic shock.
A total score above 6 may indicate that CytoSorb® could be considered in line with the clinician’s judgment and the overall clinical picture.
Diagnosis of septic shock
Start of standard therapy
Evaluation using CytoScore
Start treatment with CytoSorb
if >6 points after 6 hours, consider starting CytoSorb
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Diagnosis of septic shock
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Start of standard therapy
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Evaluation using CytoScore
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Start treatment with CytoSorb
if >6 points after 6 hours, consider starting CytoSorb
Postoperative hyperinflammation management
Major surgeries can trigger temporary systemic hyperinflammation. CytoSorb® Therapy is intended to support modulation of inflammatory balance that is critical for patient stability. When this response becomes excessive, it may contribute to organ dysfunction. CytoSorb® Therapy is designed to assist in the management of inflammatory mediators as part of multimodal patient care.
Supporting the control of post-surgical hyperinflammation
During major surgical procedures, patients often experience a transient inflammatory response that is considered physiological.
However, when this response becomes systemic and excessive, it may contribute to organ dysfunction, which is an important factor in postoperative morbidity and mortality.
CytoSorb® Therapy is designed to help manage inflammatory mediators as part of a multimodal approach to patient care.
By adsorption of excessive cytokines, CytoSorb Therapy can help to stabilize hemodynamics through:
Attenuation of hyperinflammation
Reduction in vasopressor needs
Noradrenaline and adrenaline requirements
CytoSorb demonstrates substantial and statistically significant reduced catecholamine needs, together with a restoration of hemodynamic stability.
Improvement in micro- and microcirculation
Promotion of shock reversal
Best practice therapy management
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Therapy goal
Promotion of shock reversal through:
- Attenuation of hyperinflammation
- Reduction in vasopressor needs
- Improvement of micro and macro circulation
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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
- Ideally < 12 hours after diagnosis of shock/start of standard therapy
- Don’t wait until lactate is > 6.5/7 mmol/L
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Dosing
- For severely unstable and hyper-inflamed patients, device changes every 8-12 hours at the beginning of treatment is recommended. Otherwise, daily device changes will suffice.
- Continue until sufficient hemodynamic stabilization is achieved
Support your ECMO patients
CytoSorb® Therapy is intended to support modulation of cytokine levels and help maintain organ function in ECMO patients. Despite technological advances, systemic inflammation and organ dysfunction remain common challenges.
Applications
With two main applications — Venoarterial (VA) ECMO for cardiac and pulmonary support, and venovenous (VV) ECMO for pulmonary support — ECMO is increasingly used in acute respiratory distress syndrome (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.
Enhanced lung rest: VV-ECMO
CytoSorb® Therapy is intended to assist in managing hyperinflammation and, when used in combination with VV-ECMO to facilitate lung rest, may help support pulmonary recovery and overall organ function.
Earlier intervention with CytoSorb and VV-ECMO allows for “Enhanced lung rest” in severe-ARDS patients and was associated with shorter need for ECMO therapy, mechanical ventilation (MV) and ICU stay, compared to patients with late treatment start.
Substantial and statistically significant increase in PaO₂/FiO₂ ratio and concomitant substantial and statistically significant decrease of C-Reactive Protein (CRP), Lactate and norepinephrine (NE) were observed in ARDS patients treated with hemoadsorption.
Best practice therapy management
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Therapeutic goal
Promotion of lung function recovery through the concept of “enhanced lung rest”:
- Lung rest by ECMO and concomitant treatment of hyperinflammation by CytoSorb
- Improvement in oxygenation
- Faster weaning from ECMO
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Patient selection
- ARDS with respiratory failure requiring ECMO therapy
- Clinical signs of severe hyperinflammation and/or elevated biomarkers:
- IL-6 > 500 pg/mL
- PCT > 3 μg/L
- Ferritin > 1000 μg/L
- CRP > 50 mg/L
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Timing
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Consider simultaneous integration of CytoSorb at the start of ECMO as a protocolized “enhanced lung rest” approach
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Early intervention with CytoSorb is associated with better outcomes
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Dosing
Depending on the individual clinical course:
- For patients with severe ARDS, changing the device every 12 hours for the first day is recommended, followed by daily device changes for the next 2 days, for a total of 4 devices over 72 hours. Treatment can be extended beyond 72 hours if needed.
- Change each adsorber after a maximum use time of 24 hrs
- Consider changing CytoSorb every 12 hrs if there is ongoing cardiopulmonary instability
- Re-evaluate every 12-24 hrs and continue treatment as clinically indicated
Enhance VA-ECMO Outcomes
Additional Information
- Kogelmann et al., J Clin Med 2021; 10(13):2939
- Rugg et al., Biomedicines 2020; 8(12):539
- Brouwer et al., Crit Care. 2019; 23(1):317
- Akil et al., Thorac Cardiovasc Surg 2021; 69(3):246-251
- Boss et al., PLoS One 2021; 16(2):e0246299
- Rasch S et al., Artif Org 2022; 46(6):1019-1026
- Traeger et al., Int J Artif Organs 2016; 39(3):141-146
- Leonardis et al., Case Rep Crit Care 2018:1205613
- Bottari et al., Front in Pediatrics 2023; 11:1259384
- Friesecke et al., J Artif Organs 2017; 20(3):242-259
- David et al., J Int Care 2017; 5:12
- Akil et al., J Clinical Med 2022; 11(20):5990
- Hayanga et al., Crit Care 2023; 27(1):243
- Calabrò et al., Artif Organs 2019; 43(2):189-194
- Hawchar et al., J Crit Care 2019; 49;172-178
- Kogelmann et al., J Clin Med 2024; 13(1):294
- Zuccari et al., Blood Purif 2020; 49(1-2):110 -113
- Szigetvary et al., Biomedicines 2023; 11(11):3068
- Piskovatska et al., Healthcare 2023; 11(3):310
- Kogelmann et al., J Int Care Soc 2020; 21(2):183-190
- Song, T et al., Front. Med. 2021; 8:773461
- Hayanga J et al., Crit. Care 2023; 27:243
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.