Ingo Garau1, Alexander März2, Susanne Sehner3, Daniel A Reuter2, Hermann Reichenspurner4, Christian Zöllner1, Jens C Kubitz5. 1. Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 2. Department of Anesthesiology, Rostock University Medical Center, University of Rostock, Rostock, Germany. 3. Department of Medical Biometry and Epidemiology of the University Medical Center, Hamburg-Eppendorf, Hamburg, Germany. 4. Department of Cardiothoracic Surgery, University Heart Center, Hamburg-Eppendorf, Hamburg, Germany. 5. Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany - jkubitz@uke.de.
Abstract
BACKGROUND:Surgical trauma and cardiopulmonary bypass (CPB) are associated with the liberation of pro-inflammatory cytokines. With hemadsorption (Cytosorb®) during CPB, pro-inflammatory cytokines may be reduced and the inflammatory response may be decreased. METHODS: In this prospective, randomized single center study, serum cytokine levels of interleukin 8 (Il-8), interleukin 6 (Il-6) and tumor-necrosis-factorα (TNFα) were assessed in elective on-pump cardiac surgery patients with hemadsorption on CPB (study group [SG], N.=20) and without (control group [CG], N.=20). Cytokine levels were assessed prior to CPB, at the end of CPB, and 6 hours (h) and 24 h after the end of CPB, together with a hemodynamic assessment. Cardiac-Index (CI) was assessed with transcardiopulmonary thermodilution. RESULTS: For Il-8, significantly lower serum levels were observed in the SG compared to the CG at the end of CPB (P=0.008). In the SG, TNFα levels were also below those in the CG at both the end of and 6h after CPB (P=0.034). After 24 hours, TNFα levels were at baseline in both groups. No significant differences were found for Il-6. The CI was significantly higher in the SG at the end of CPB (P=0.025). However, there was no difference between both groups 6 h after CPB. CONCLUSIONS: This prospective study shows a significant reduction in pro-inflammatory cytokine levels of Il-8 and TNFα with hemadsorption in on-pump cardiac surgery whilst also demonstrating safety in its applications. However, the differences in cytokine levels and CI between patients treated with hemadsorption and those without were minor and of short duration.
RCT Entities:
BACKGROUND: Surgical trauma and cardiopulmonary bypass (CPB) are associated with the liberation of pro-inflammatory cytokines. With hemadsorption (Cytosorb®) during CPB, pro-inflammatory cytokines may be reduced and the inflammatory response may be decreased. METHODS: In this prospective, randomized single center study, serum cytokine levels of interleukin 8 (Il-8), interleukin 6 (Il-6) and tumor-necrosis-factor α (TNFα) were assessed in elective on-pump cardiac surgery patients with hemadsorption on CPB (study group [SG], N.=20) and without (control group [CG], N.=20). Cytokine levels were assessed prior to CPB, at the end of CPB, and 6 hours (h) and 24 h after the end of CPB, together with a hemodynamic assessment. Cardiac-Index (CI) was assessed with transcardiopulmonary thermodilution. RESULTS: For Il-8, significantly lower serum levels were observed in the SG compared to the CG at the end of CPB (P=0.008). In the SG, TNFα levels were also below those in the CG at both the end of and 6h after CPB (P=0.034). After 24 hours, TNFα levels were at baseline in both groups. No significant differences were found for Il-6. The CI was significantly higher in the SG at the end of CPB (P=0.025). However, there was no difference between both groups 6 h after CPB. CONCLUSIONS: This prospective study shows a significant reduction in pro-inflammatory cytokine levels of Il-8 and TNFα with hemadsorption in on-pump cardiac surgery whilst also demonstrating safety in its applications. However, the differences in cytokine levels and CI between patients treated with hemadsorption and those without were minor and of short duration.