Early Impact of Cytosorb® Adsorber on Proinflammatory Cytokine Plasmatic Levels in a Porcine Model of Refractory Cardiogenic Shock Supported with VA-ECMO

Abstract Background. Cardiogenic shock (CS) is a pejorative situation which often requires a circulatory support with VA-ECMO. However, VA-ECMO is known to trigger an inflammatory cascade with expression of proinflammatory cytokines Interleukin-6 (IL-6) and Interleukin-10 (IL-10) causing organ damages and hemodynamic deterioration. Cytokine adsorption using the Cytosorb® adsorber was recently proposed to mitigate the inflammatory response. As relevance of implementing Cytosorb® adsorber with VA-ECMO is not validated, we sought to assess whether it might early influence levels of IL-6 and IL-10 in a porcine model of ischemic refractory CS. Materials and Methods. CS was induced in 12 male pigs following acute proximal occlusion of the left anterior descending artery (LAD). After a low-flow period of 60 minutes, circulatory support with VA-ECMO was initiated and pigs were randomly assigned in two groups, Cytosorb® (−) (VA-ECMO without Cytosorb®adsorber: n = 6) and Cytosorb® (+) (VA-ECMO with Cytosorb®adsorber: n = 6). In each group, modulation of IL-6 and IL-10 was assessed during a four-hour procedure, as well as impact on arterial blood pressure, biological and biochemical, parameters. Results. After 240 minutes, the Group Cytosorb® (+) demonstrated a significant propensity to reduce levels of IL-10, (p = 0.0421*). Regarding hemodynamics, biological and biochemical parameters, Cytosorb® adsorber showed no difference with the group Cytosorb® (−). Conclusions. Despite encouraging early benefits, further studies are still necessary to validate interests of a routine use of Cytosorb®adsorber with VA-ECMO.