Abstract Background Acute brain injury can precipitate a profound systemic inflammatory response characterized by marked elevations in interleukin-6 (IL-6), a mediator linked to blood-brain barrier disruption, cerebral edema, hemodynamic instability, and secondary neurological deterioration. Effective immunomodulation strategies are limited, and extracorporeal hemoperfusion using cytokine-adsorption cartridges has emerged as a potential therapy to attenuate cytokine storm physiology. However, its role in neurocritical care remains largely unexplored. Objective To describe the effect of adjunctive hemoperfusion on IL-6 reduction and clinical trajectories in neurocritical patients with acute brain injury and severe systemic hyperinflammation. Methods We conducted a retrospective case series of nine adults admitted to a neurocritical care unit between January-June 2025 with severe traumatic or hemorrhagic brain injury and extremely elevated IL-6 at admission (mean 323 pg/mL). All underwent hemoperfusion (CytoSorb® or Jafron®) in addition to guideline-based neurocritical management. IL-6 concentrations were recorded at baseline and serially over 7 days. Clinical evolution was assessed through hemodynamic variables, vasopressor needs, and radioclinical markers of cerebral edema. Device performance (CytoSorb® vs. Jafron®) and procedure-related adverse events were documented. Results Hemoperfusion yielded a rapid and sustained decrease in circulating IL-6, falling from a mean 323 pg/mL at baseline to 76 pg/mL by day 2, 36 pg/mL by day 5, and 17 pg/mL by day 7. This biochemical response coincided with meaningful clinical improvements. Vasopressor requirements decreased notably by day 3, and several patients were weaned earlier than anticipated. Importantly, the expected peak in cerebral edema around day 3 post-injury was attenuated across the cohort, with radiologic and clinical stabilization observed rather than worsening. CytoSorb® showed greater IL-6 clearance and clinical benefit than Jafron® in this small sample. Hemoperfusion was well tolerated: only one transient over-anticoagulation event occurred during Jafron® use, without hemodynamic collapse, ICP destabilization, or neurologic deterioration in any patient. Conclusion Early adjunctive hemoperfusion was associated with profound IL-6 reduction and favorable hemodynamic and neuro-edema profiles in patients with acute brain injury and hyperinflammatory physiology. This strategy appeared safe and may represent a promising immunomodulatory adjunct to mitigate secondary brain injury and prevent systemic complications such as refractory cerebral edema, ARDS, and hyperinflammatory syndromes. These results highlight IL-6 as a mechanistically relevant biomarker and therapeutic target in neurocritical care and justify prospective controlled trials to define optimal timing, device selection, and patient phenotypes most likely to benefit. This abstract is funded by: N/A
Carrizosa et al. (Fri,) studied this question.