Early impact of CytoSorb® adsorber on proinflammatory cytokine plasmatic levels in a porcine model of refractory cardiogenic shock supported with VA-ECMO

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 min, 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 min, 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.