Hemoadsorption (CytoSorb®) in management of Cytokine Storm - Implication
in COVID-19 pandemic.
Background: Sepsis-related deaths contribute up to 20% of all global
deaths, with the highest-burden from sub-Saharan Africa and Southeast
Asia. Cytokines are the mediators of organ dysfunction in systemic
inflammatory response syndrome (SIRS) across varied aetiologies,
including sepsis. The imbalance of pro and anti-inflammatory cytokines
continues to be the crux of the pathophysiology of organ dysfunction in
septic shock. Therapies to treat cytokines either by antagonizing them
or filtering them out of the body are evolving. Hemoadsorption is a
process of filtering out cytokines and other metabolites involved in
SIRS by surface adsorption. Methods: We searched for terms –
Hemoadsorption; CytoSorb; in PubMed. We enrolled manuscripts with
patients at Indian Centres for review. We extend our review of cytokine
storm in COVID-19 and the utility of CytoSorb as an adjuvant in the
management of septic shock in COVID-19. Results: Severe acute
respiratory syndrome coronavirus -2 (SARS-CoV-2) infection causing
COVID-19 (Corona Virus disease - 2019) pandemic has affirmed cytokine
storm as the principle pathology causing morbidity and mortality.
Management strategies are mostly supportive since specific anti-viral
therapy is still in the incipient stage. Cytokine adsorption is being
used across most western countries in COVID-19 septic shock.
Conclusion: COVID-19 with cytokine storm as its main pathology is a
suitable substrate for the use of CytoSorb. COVID-19 patients with
elevated cytokine levels can be offered CytoSorb® hemoadsorption along
with other supportive therapies.