Haemadsorption therapy cuts death, ICU stay after nonelective cardiac surgery

Using cytokine filters for haemadsorption therapy helps reduce 30-day mortality and intensive care unit (ICU) stays in patients undergoing cardiac surgery involving cardiopulmonary bypass (CPB), a recent study has found.

Researchers performed a systematic review and meta-analysis of 15 studies, 13 of which looked at operative mortality up to 30 days after surgery. Pooled analysis revealed no significant benefit of haemadsorption therapy overall (odds ratio [OR], 0.69, 95 percent confidence interval [CI], 0.31–1.52; p=0.350).

However, subgroup analysis revealed that cytokine filters were significantly beneficial in nonelective surgeries such as for emergencies and infective endocarditis, where haemadsorption therapy cut the likelihood of 30-day mortality by 60 percent (OR, 0.40, 95 percent CI, 0.20–0.83; p=0.01).

ICU stay was also shorter by more than 40 hours in this subgroup of patients treated with cytokine filters (mean difference [MD], –42.36 hours, 95 percent CI, –68.07 to –16.65; p=0.001).

Similarly, 1 day after surgery, patients undergoing haemadsorption showed significantly lower C-reactive protein levels (MD, –0.71, 95 percent CI, –0.84 to –0.59; p<0.001), though no such effect was reported for interleukins and lactate.

Cytokine filters had no significant impact on ventilation duration, hospital stay, and length of ICU stay in the overall patient sample across all studies included.

“At present there are only observational studies for this cohort of patients. We recommend designing well-conducted, large-scale randomized controlled trials in patients with infective endocarditis, [which] will likely provide further results on the benefits of cytokine filters use,” the researchers said.