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Hemoadsorption (CytoSorb®) in management of Cytokine Storm - Implication in COVID-19 pandemic.
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  • Harish Mallapura Maheshwarappa,
  • Shreedhar Joshi,
  • Robert Premkumar,
  • Shivangi Mishra,
  • Shiva Prasad,
  • Muralidhar Kanchi
Harish Mallapura Maheshwarappa
Narayana Hrudayalaya Foundation
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Shreedhar Joshi
Narayana Hrudayalaya Foundation
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Robert Premkumar
Mazumdar Shaw Medical Centre
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Shivangi Mishra
Narayana Hrudayalaya Foundation

Corresponding Author:[email protected]

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Shiva Prasad
Narayana Hrudayalaya Foundation
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Muralidhar Kanchi
Narayana Hrudayalaya Foundation
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Abstract

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.