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Cytokine adsorption in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation (CYCOV): a single centre, open-label, randomised, controlled trial.
Supady, Alexander; Weber, Enya; Rieder, Marina; Lother, Achim; Niklaus, Tim; Zahn, Timm; Frech, Franziska; Müller, Sissi; Kuhl, Moritz; Benk, Christoph; Maier, Sven; Trummer, Georg; Flügler, Annabelle; Krüger, Kirsten; Sekandarzad, Asieb; Stachon, Peter; Zotzmann, Viviane; Bode, Christoph; Biever, Paul M; Staudacher, Dawid; Wengenmayer, Tobias; Graf, Erika; Duerschmied, Daniel.
  • Supady A; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany; Heidelberg Institute of Global Health, University
  • Weber E; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Medical Center, Faculty of Medicine, University of Freiburg, Germany.
  • Rieder M; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Lother A; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Niklaus T; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Zahn T; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Frech F; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Müller S; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Kuhl M; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Benk C; Department of Cardiovascular Surgery, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Maier S; Department of Cardiovascular Surgery, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Trummer G; Department of Cardiovascular Surgery, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Flügler A; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Krüger K; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Sekandarzad A; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Stachon P; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Zotzmann V; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Bode C; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Biever PM; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Staudacher D; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Wengenmayer T; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
  • Graf E; Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Germany; Medical Center, Faculty of Medicine, University of Freiburg, Germany.
  • Duerschmied D; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Germany.
Lancet Respir Med ; 9(7): 755-762, 2021 07.
Статья в английский | MEDLINE | ID: covidwho-1337041
ABSTRACT

BACKGROUND:

We sought to clarify the benefit of cytokine adsorption in patients with COVID-19 supported with venovenous extracorporeal membrane oxygenation (ECMO).

METHODS:

We did a single-centre, open-label, randomised, controlled trial to investigate cytokine adsorption in adult patients with severe COVID-19 pneumonia requiring ECMO. Patients with COVID-19 selected for ECMO at the Freiburg University Medical Center (Freiburg, Germany) were randomly assigned (11) to receive cytokine adsorption using the CytoSorb device or not. Randomisation was computer-generated, allocation was concealed by opaque, sequentially numbered sealed envelopes. The CytoSorb device was incorporated into the ECMO circuit before connection to the patient circuit, replaced every 24 h, and removed after 72 h. The primary endpoint was serum interleukin-6 (IL-6) concentration 72 h after initiation of ECMO analysed by intention to treat. Secondary endpoints included 30-day survival. The trial is registered with ClinicalTrials.gov (NCT04324528) and the German Clinical Trials Register (DRKS00021300) and is closed.

FINDINGS:

From March 29, 2020, to Dec 29, 2020, of 34 patients assessed for eligibility, 17 (50%) were treated with cytokine adsorption and 17 (50%) without. Median IL-6 decreased from 357·0 pg/mL to 98·6 pg/mL in patients randomly assigned to cytokine adsorption and from 289·0 pg/mL to 112·0 pg/mL in the control group after 72 h. One patient in each group died before 72 h. Adjusted mean log IL-6 concentrations after 72 h were 0·30 higher in the cytokine adsorption group (95% CI -0·70 to 1·30, p=0·54). Survival after 30 days was three (18%) of 17 with cytokine adsorption and 13 (76%) of 17 without cytokine adsorption (p=0·0016).

INTERPRETATION:

Early initiation of cytokine adsorption in patients with severe COVID-19 and venovenous ECMO did not reduce serum IL-6 and had a negative effect on survival. Cytokine adsorption should not be used during the first days of ECMO support in COVID-19.

FUNDING:

None.
Тема - темы

Полный текст: Имеется в наличии Коллекция: Международные базы данных база данных: MEDLINE Основная тема: Extracorporeal Membrane Oxygenation / Cytokines / COVID-19 Тип исследования: Экспериментальные исследования / Прогностическое исследование / Рандомизированные контролируемые испытания Пределы темы: Взрослые / Пожилые / Женщины / Люди / Мужчины / Middle aged Язык: английский Журнал: Lancet Respir Med Год: 2021 Тип: Статья

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Полный текст: Имеется в наличии Коллекция: Международные базы данных база данных: MEDLINE Основная тема: Extracorporeal Membrane Oxygenation / Cytokines / COVID-19 Тип исследования: Экспериментальные исследования / Прогностическое исследование / Рандомизированные контролируемые испытания Пределы темы: Взрослые / Пожилые / Женщины / Люди / Мужчины / Middle aged Язык: английский Журнал: Lancet Respir Med Год: 2021 Тип: Статья