Efficacy of CytoSorb® - A Metaanalysis

Abstract Cytokine adsorption using the CytoSorb® device has been proposed in various clinical settings including sepsis, ARDS, hyperinflammatory syndromes, cardiac surgery or recovery after cardiac arrest. The aim of this analysis is to provide evidence for the efficacy of the CytoSorb® device with regard to mortality in various settings. Methods: We searched PubMed, Cochrane Library database and the database provided by Cytosorbents™ (01.1.2010–29.5.2022). We considered randomized controlled trials and intervention studies with control groups. The longest reported mortality was defined as primary endpoint. For analyzing the data, we computed risk ratios and 95%-confidence intervals and used DerSimonian and Lairds random effects model. We analyzed all studies combined and divided into the subgroups sepsis, cardiac surgery, other severe illness, SARS-CoV-2 infection and recovery from cardiac arrest. The meta-analysis was registered in advance (PROSPERO: CRD42022290334). Results: Of an initial 1295 publications, 34 studies were found eligible, including 1297 patients treated with CytoSorb® and 1314 controls. Cytosorb® did not lower mortality in all studies together (1.07 [0.88; 1.31] RR [95%-CI]), in sepsis (0.98 [0.74; 1.31]), CPB surgery (0.91 [0.64; 1.29]), severe illness (0.95 [0.59; 1.55]) or SARS-CoV-2 (1.58 [0.50; 4.94]). In patients with cardiac arrest, we found a significant survival advantage of the untreated controls (RR 1.22 [1.02; 1.46]). We did not find significant differences in ICU length of stay, lactate levels, or IL-6 levels after treatment. Interpretation: To date there is no evidence for a positive effect of the CytoSorb® adsorber on mortality across a variety of indications that justifies its widespread use in intensive care medicine.