The Role of CytoSorb device to regain control in critical ill COVID-19 patients

CytoSorb 
The CytoSorb Device is non pyrogenic, sterile, single use device containing adsorbent polymer beads designed to remove cytokine, as blood passes through the device. CytoSorb is placed in a blood pump circuit.




CytoSorb is a European Union-approved extracorporeal cytokine adsorber, designed to broadly reduce cytokine strom and other inflammatory mediators in the blood that could otherwise lead to uncontrolled systemic inflammation, organ failure, and death in many life-threatening illnesses. 


COVID-19 background 
There are two problems in severe COVID-19 infection. First, the virus infects the lower respiratory track, causing direct pulmonary injury through viral replication, leading to viral pneumonia and pneumonitis. The virus is also detected in the bloodstream, and may cause direct cardiac injury, liver injury, and other remote organ injury 

The sceond problem in coronavirus COVID-19 infection is the development of a cytokine storm, driving a severe systemic inflammatory response syndrome (SIRS), capillary leak syndrome, organ injury and other complications. In critically ill patients in ICU, this contributes to high risk of death due to a high incidence of complication such as ARDS, Shock, kidney injury, acute cardiac injury and other organ dysfunction 

Rationale 
CytoSorb is broadly indicated for use in situations where cytokine are elevated, which include the treatment of coronavirus COVID-19 complication.

CytoSorb has been used safely in more than 80,000 treatment worldwide, primarily in treatment of systemic hyperinflammation in a wide variety of life-threatening conditions such as septic shock, influenza, ARDS, secondary HLH, trauma, liver failure, pancreatitis and many other 

Indications
CytoSorb is indicated for use in conditions where elevated levels of cytokines are present Maximum treatment time per Device 24 hours 

Administration of therapy:
Day 1: Change device every 12 hours 
Day 2: Change device at 24 hours,
Day 3: Change device at 24 hours.

General Precautions
  • CytoSorb only be administered by person who have been properly trained in administration of extracorporeal therapies. 
  • The extracorporeal circuit should be monitored continuously during treatment for blood leak 
  • Many patients with COVID-19 infection are known to be hyper-coagulable. Refers for specific guidance regarding anticoagulant

What do I need to know about the emergency use CytoSorb device ?
The CytoSorb device has been authorised under EUA(Emergency use Authorisation) for emergency use for treatment of patients with confirmed COVID-19 who are showing certain severe symptoms including high fever persistent cough, developing more difficulty in breathing or indicating likely to be more ill within the next 1-24 hours. This device have potential to remove substances in your blood that are not allowing the immune system to function normally. 

Benifits and Risks 
Potential benifits of CytoSorb device
  • Removal of substance from the blood that are causing your immune system to not function properly.

Potential risks includes 
  • Very low blood pressure and reduced delivery of blood to vital organs 
  • Abnormal heart rhythm 
  • Bleeding 
  • Low level of blood protein ( e.g. Albumin) 
  • Clotting 
  • Stroke from air in bloodstream 
  • Infection 
  • Damage to the blood cell 
  • Low level of blood calcium 
  • Reduction in blood cells ( platelets and white blood cells ) 
  • Allergic reaction to device 
  • Removal of other substances from blood e.g vitamins, proteins, medications 
  • Risks related to catheter placement for blood access e.g. infection, bleeding, clotting, tissue/organ injury
  • Risks related to blood-thinners e.g bleeding allergic reaction
Conclusion 
CytoSorb therapy may be a promising and important therapeutic option to help manage the serious complications caused by cytokine storm and hyperinflation in critically-ill COVID-19 patients.

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