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Abstract: PO0157

CytoResc, or CytoSorb for COVID-19 Patients with Vasoplegic Shock: A Prospective Randomized Pilot Study

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Stockmann, Helena, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Thelen, Philipp, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Pigorsch, Mareen, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Eckardt, Kai-Uwe, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Enghard, Philipp, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Lehner, Lukas J., Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
Background

Several observations indicate a hyperinflammatory state in severely ill COVID-19 patients as target for therapeutic interventions. The aim of this study was to investigate the effect of extracorporeal cytokine elimination by CytoSorb on COVID-19 associated vasoplegic shock.

Methods

In this prospective randomized pilotstudy patients with vasoplegic shock requiring norepinephrine >0.2 µg/kg/min, CRP >100 mg/L and indication for kidney replacement therapy were randomized 1:1 to receive CytoSorb treatment for 3-7 days or standard of care. The primary endpoint was time until resolution of vasoplegic shock (freedom of vasopressor therapy for at least 8 hours to sustain a MAP ≥65mmHg). Data were analyzed using Cox-regression and Kaplan-Meier curves.

Results

From November 2020 - March 2021 50 patients were enrolled. Of these 23 patients received CytoSorb treatment, 26 patients received standard of care and 1 patient had to be excluded due to withdrawal of informed consent. The median age was 61 (IQR 58-65) years in the CytoSorb group and 66 (IQR 60-71) years in the control group. Patients were predominantly male (CytoSorb 91.3% vs. control 76.9%). Comorbidities and indicators for disease severity were well balanced. The primary endpoint was reached in 13/23 patients (56.5%) in the CytoSorb and 12/26 patients (46.2%) in the control group after a median of 5 (IQR 4-5) and 4 days (IQR 3-5), respectively (Figure 1a). The Cox-regression analysis for the primary endpoint showed no statistically significant difference between the groups with and without adjustment for the predefined additional variables age, gender, ECMO-therapy or time from beginning of shock until study inclusion. ICU-mortality was high with 18/23 (78%) deaths in the CytoSorb and 19/26 (73%) deaths in the control group (Figure 1b).

Conclusion

In this pilot trial in severely ill COVID-19 patients CytoSorb treatment did neither lead to a faster resolution of vasoplegic shock as compared to standard of care, nor was it associated with altered mortality.