Early use of hemoadsorption in patients after out-of hospital cardiac arrest - a matched pair analysis

• Published in: PloS one Vol. 15; no. 11; p. e0241709
• Main Authors: Akin, Muharrem, Garcheva, Vera, Sieweke, Jan-Thorben, Flierl, Ulrike, Daum, Hannah C, Bauersachs, Johann, Schäfer, Andreas
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03.11.2020; Public Library of Science (PLoS)
• Subjects: Adsorbents; Aged; Biology and Life Sciences; Blood filters; Cardiac arrest; Cardiology; Cardiopulmonary Resuscitation; Cardiovascular disease; Care and treatment; Clinical trials; CPR; Cytokines; Ethics; Female; Glomerular filtration rate; Glomerular Filtration Rate - physiology; Health aspects; Heart; Heart surgery; Hospitals; Humans; Hypothermia; Inflammation; Kaplan-Meier Estimate; Lactic acid; Male; Medical schools; Medicine and Health Sciences; Metabolism; Middle Aged; Mortality; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - therapy; Oxygenation; Patients; Prospective Studies; Renal replacement therapy; Research and Analysis Methods; Resuscitation; Sepsis; Stroke Volume - physiology; Surgery; Tumor necrosis factor-TNF; Unloading; Ventricle; Finland; Germany
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0241709

Pro- and anti-inflammatory mediators are released during and after cardiac arrest, which may be unfavourable. Small case-series and observational studies suggested that unselective hemoadsorption may reduce inadequately high cytokine levels during sepsis or cardiac surgery. We aimed to assess the effect of cytokine adsorbtion on mortality in patients following out-of-hospital cardiac arrest by comparing a patient cohort with hemoadsorption after resuscitation for out-of-hospital cardiac arrest to a control cohort without adsorption within the HAnnover COling REgistry (HACORE). We adopted an early routine use of hemoadsorption in patients after out-of-hospital cardiac arrest with increased vasopressor need and performed a 1:2 match according to age, gender, time to return of spontaneous circulation, initial left-ventricular ejection fraction, extracorporeal membrane-oxygenation or left-ventricular unloading by Impella, need for renal replacement therapy, admission lactate, pH, glomerular filtration rate to patients without an adsorber from HACORE. The primary endpoint was 30-day mortality. Twenty-four patients receiving hemoadsorption were matched to 48 patients without hemoadsorption (mean age 62±13 years, 83% male). While there was no significant difference in baseline parameters, 30-day mortality was higher in patients treated with hemoadsorption than in the matched control group (83% vs 65%, Log rank p = 0.011). Routine use of hemoadsorption did not reduce, but seems to be associated with higher 30-day mortality in patients after OHCA. Prior to routine adoption in daily practice, hemoadsorption should be evaluated in properly sized randomized controlled trials.