The following is a summary of “REmoval of cytokines during CArdiac surgery (RECCAS): a randomised controlled trial,” published in the December 2024 issue of Critical Care by Hohn et al.
Cardiopulmonary bypass (CPB) is known to induce a significant inflammatory response characterized by cytokine release and systemic inflammatory response syndrome, which can contribute to adverse postoperative complications.
Researchers conducted a retrospective study to examine the impact of intraoperative hemoadsorption (HA) during cardiac surgery with CPB on postoperative systemic inflammatory response.
They performed a randomized controlled trial (ethics approval no. 5094-14DRKS00007928) involving individuals over 65 years undergoing elective on-pump cardiac surgery. Participants were randomized to receive intraoperative HA (CytoSorb) during CPB or standard care without HA. The primary outcome was the difference in mean interleukin (IL)-6 serum levels between groups at intensive care unit (ICU) admission. Secondary outcomes included various clinical and biochemical measures. Statistical analysis utilized paired and unpaired t-tests, Wilcoxon tests, Mann–Whitney U-tests, and chi-square tests.
The results showed 38 individuals were assigned to receive either intraoperative HA (n = 19) or standard care (n = 19). There was no significant difference in IL-6 levels at ICU admission between the groups (214.4 ± 328.8 vs 155.8 ± 159.6 pg/ml, P = 0.511). IL-2, IL-6, IL-8, IL-10, heparan sulfate, and myoglobin levels were reduced after the adsorber during surgery, IL-6 levels did not differ between groups on ICU days 1 and 2. No statistically significant differences were found in sequential organ failure assessment scores, lactate levels, C-reactive protein, and procalcitonin (PCT). In the treatment group, the cardiac index on ICU Day 2 was higher (3.2 ± 0.7 vs 2.47 ± 0.47 l/min/m2, P = 0.012), with reduced fluid and fibrinogen requirements. The need for renal replacement therapy did not differ, although the duration was shorter in the treatment group. No differences were observed in time on the ventilator, respiratory parameters, infectious complications, delirium scores, ICU or hospital length of stay, or mortality.
Investigators concluded the intraoperative HA reduced cytokine load during cardiac surgery, however, it did not significantly impact IL-6 levels on ICU admission or subsequently, nor did it affect other key postoperative outcomes such as organ dysfunction, ICU and hospital lengths of stay, or mortality rates.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05175-9
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