Rationale of using CytoSorb Therapy in critically ill COVID-19 patients
CytoSorb is a European Union-approved extracorporeal cytokine adsorber, designed to broadly reduce cytokine storm and other inflammatory mediators in the blood that could otherwise lead to uncontrolled systemic inflammation, organ failure, and death in many life-threatening illnesses. CytoSorb has been used safely in more than 80,000 treatments worldwide, primarily in the treatment of systemic hyperinflammation in a wide variety of life-threatening conditions.
On 10 April 2020 the US Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) (*) for emergency use of CytoSorb to treat patients 18 years of age or older with confirmed COVID-19 admitted to the ICU with confirmed or imminent respiratory failure by reducing pro-inflammatory cytokine levels, which may ameliorate a cytokine storm due to the overabundance of pro-inflammatory cytokines and, in turn, provide clinical benefit to such patients.
Experience in Treating Patients with COVID-19 infection
The rationale of using blood purification to treat cytokine storm in critically-ill COVID-19 patients was recently detailed by a recent publication that concluded, “Finally, a sepsis-like syndrome might occur frequently due to the virus itself or to a superimposed bacterial infection and in this case, since pharmacological approaches have shown poor results, new extracorporeal organ support therapies including hemoadsorption and hemoperfusion, with new sorbent cartridges designed to remove cytokines and other circulating mediators, should be considered.” (1)
To date, more than 500 critically ill patients with COVID-19 infection have been treated with CytoSorb in various centers in Italy, China and Germany. Although patient level data is not yet available due to the extraordinary circumstances in these countries, the positive results in Italy have led to the formal recommendation by the Italy Brescia Renal COVID Task Force and published by the Italian Society of Nephrology and ERA-EDTA, to specifically use CytoSorb in severe COVID-19 patients with Stage 3 AKI receiving Continuous Renal Replacement Therapy (CRRT). (2) Also, the recent National Guidelines on adult COVID-19 patients from Panama recommend CytoSorb Therapy. (3) In addition, the recent Handbook of COVID-19 Prevention and Treatment from Zhejiang University School of Medicine, China, is also recommending blood purification to treat cytokine storm in critical cases of COVID-19 infection. (4)