Hemoadsorption in Emerging Economies: Translating Therapeutic Promise into Clinical Practice

Critical illness and sepsis place a substantial burden on emerging healthcare systems, where delayed presentation and referral, limited diagnostic and monitoring capacity, a high burden of antimicrobial resistance, variable intensive care and extracorporeal infrastructure, workforce shortages, and substantial out-of-pocket healthcare costs may complicate the management of septic shock. Prompt antimicrobial therapy, source control, hemodynamic stabilization, and organ support remain the foundation of care; however, some patients develop persistent shock and progressive organ dysfunction despite optimized conventional treatment. In this context, hemoadsorption has emerged as a potential adjunctive therapy aimed at modifying components of the dysregulated host response.Despite its biological rationale and effects on circulating inflammatory mediators, improvements in surrogate markers have not consistently translated into better patient outcomes. Important uncertainties regarding optimal patient selection, timing,and treatment intensity therefore remain. A pragmatic approach in emerging economies should prioritize carefully selected patients with persistent vasopressor- dependent shock, progressive organ dysfunction and a clinically relevant hyperinflammatory phenotype despite optimized standard care. Treatment decisions should be guided primarily by clinical presentation and trajectory rather than rigidtime thresholds or reliance on a single biomarker. Multidisciplinary assessment, transparent communication regarding potential benefits, limitations, uncertainties, risks, and financial implications, and predefined clinically meaningful endpoints are essential. Serial reassessment should guide treatment continuation, modification, or cessation. Prospective documentation of outcomes, complications, resource utilization, and affordability is needed to strengthen locally relevant evidence. Ultimately, the value of hemoadsorption in emerging economies will depend on its appropriate, equitable, and context-sensitive integration into existing healthcare systems.