The following is a summary of “Extracorporeal hemoadsorption in critically ill COVID-19 patients on VV ECMO: the CytoSorb therapy in COVID-19 (CTC) registry,” published in the June 2023 issue of Critical Care by Hayanga et al.
For a study, researchers aimed to establish the CytoSorb therapy in COVID-19 (CTC) registry to analyze the effectiveness of CytoSorb therapy combined with venovenous extracorporeal membrane oxygenation (VV ECMO) in critically ill COVID-19 patients with acute respiratory distress syndrome (ARDS) and respiratory failure under US FDA Emergency Use Authorization.
They build a multicenter, observational registry (NCT04391920) device for CTC. Between April 2020 and January 2022, they set 5 prominent US academic centers monitored intensive care units (ICUs). A group of 100 severely ill adults with COVID-19-induced ARDS necessitating VV ECMO support underwent treatment with extracorporeal hemoadsorption. There were no interventions involved.
Study group obtained approval from individual ethics committees at each center, baseline demographics, clinical characteristics, laboratory values, and documented outcomes. Comprehensive data regarding the utilization of organ support parameters and hemoadsorption treatments were systematically collected. Biomarker data were collected based on the standard protocols at each participating site, and a comparison was made between the available values before and after the administration of hemoadsorption.
They used a time-to-event analysis to evaluate the primary outcome of mortality. The study included 100 patients (63% male; mean age 44 ± 11 years). Survival rates were 86% at 30 days and 74% at 90 days. The median time from ICU admission to the initiation of hemoadsorption was 87 hours and was used to define two post hoc groups: ≤ 87 h (group-early start, GE) and > 87 h (group-late start, GL).
Patients in the GE who underwent hemoadsorption had significantly shorter median durations of mechanical ventilation (7 [2–26] vs. 17 [7–37] days, P= 0.02), ECMO support (13 [8–24] vs. 29 [14–38] days, P= 0.021) and ICU stay (17 [10–40] vs 36 [19–55] days, P= 0.002). The survival rate at 90 days was 82% in GE compared to 66% in the GL (P= 0.14). There were no reported adverse events associated with the device.
They concluded that in critically ill patients with severe COVID-19-related ARDS who received combined VV-ECMO and hemoadsorption, the 90-day survival rate was 74%, and earlier intervention was linked to reduced duration of organ support requirement and ICU stay. These findings provide evidence to support the idea of “enhanced lung rest” achieved through the combined utilization of VV-ECMO and hemoadsorption in patients with ARDS.