背景:体外血液净化已广泛用于重症监护医学,肾脏病学,毒理学,和其他领域。在过去的十年里,随着新型吸附性血液净化装置的出现,在心脏手术的CPB中,血液吸收越来越多的应用,对于不同炎症风险的患者,或术后并发症。迄今为止,临床证据尚未提供有关这种辅助治疗的明确答案。当前的系统评价旨在严格评估围手术期血液吸收在心脏手术中的作用,通过总结目前的知识在这个临床设置。
方法:PubMed的文献检索,科克伦图书馆,CytoSorbents提供的数据库是在6月1日进行的,2023年。搜索词是通过应用中性搜索关键词来选择的,以执行无偏见的系统搜索,包括术语“心脏手术”和“血液吸收”的语言变体。筛选和选择过程遵循科学原则(PRISMA声明)。如果摘要是用英文撰写并在过去十年内出版,则考虑将其包含在内。如果报告来自任何类型的研究(不包括病例报告)的原始数据,在心脏手术期间或之后对血液吸附装置进行了研究,则出版物有资格进行评估。根据子字段总结结果,并以表格视图显示。
结果:搜索结果产生了29篇出版物,共有1,057名接受血液吸附治疗的患者和988名对照患者。由于研究设计的显着变异性,文章进行了分组和描述性分析,然而,所有报道都是CytoSorb®治疗。总共62%(18/29)的纳入文章报告了安全性,没有观察到意外的不良事件。与血液吸收相关的最常见的临床结果是血管加压药需求减少,从而导致更好的血液动力学稳定性。
结论:在选定的感染性心内膜炎高危病例中,血液吸附在心脏手术中的作用似乎是合理的,主动脉手术,心脏移植,以及抗血栓治疗患者的急诊手术,以及那些炎症反应失调的人,血管停搏,或术后感染性休克。未来的大型随机对照试验需要更好地定义适当的患者选择,给药,和治疗的时机。
BACKGROUND: Extracorporeal blood purification has been widely used in intensive care medicine, nephrology, toxicology, and other fields. During the last decade, with the emergence of new adsorptive blood purification devices, hemoadsorption has been increasingly applied during CPB in cardiac surgery, for patients at different inflammatory risks, or for postoperative complications. Clinical evidence so far has not provided definite answers concerning this adjunctive treatment. The current systematic
review aimed to critically assess the role of perioperative hemoadsorption in cardiac surgery, by summarizing the current knowledge in this clinical setting.
METHODS: A literature search of PubMed, Cochrane library, and the database provided by CytoSorbents was conducted on June 1st, 2023. The search terms were chosen by applying neutral search keywords to perform a non-biased systematic search, including language variations of terms \"cardiac surgery\" and \"hemoadsorption\". The screening and selection process followed scientific principles (PRISMA statement). Abstracts were considered for inclusion if they were written in English and published within the last ten years. Publications were eligible for assessment if reporting on original data from any type of study (excluding case reports) in which a hemoadsorption device was investigated during or after cardiac surgery. Results were summarized according to sub-fields and presented in a tabular view.
RESULTS: The search resulted in 29 publications with a total of 1,057 patients who were treated with hemoadsorption and 988 control patients. Articles were grouped and descriptively analyzed due to the remarkable variability in study designs, however, all reported exclusively on CytoSorb® therapy. A total of 62% (18/29) of the included articles reported on safety and no unanticipated adverse events have been observed. The most frequently reported clinical outcome associated with hemoadsorption was reduced vasopressor demand resulting in better hemodynamic stability.
CONCLUSIONS: The role of hemoadsorption in cardiac surgery seems to be justified in selected high-risk cases in infective endocarditis, aortic surgery, heart transplantation, and emergency surgery in patients under antithrombotic therapy, as well as in those who develop a dysregulated inflammatory response, vasoplegia, or septic shock postoperatively. Future large randomized controlled trials are needed to better define proper patient selection, dosing, and timing of the therapy.