# Is There a Rationale for Haemoadsorption with Combined Use of CytoSorb® and Oxiris® in Patients with Underlying Viral Infection and Secondary Bacterial Sepsis?

## TL;DR

This study explores combining CytoSorb® and Oxiris® to treat patients with viral infections and bacterial sepsis, showing improved outcomes and safety.

## Contribution

The study provides empirical evidence for the combined use of CytoSorb® and Oxiris® in treating sepsis in patients with viral infections.

## Key findings

- Combined use led to significant decreases in vasopressor requirement, SOFA score, and inflammatory markers.
- Improvements in oxygenation and no device-related adverse events were observed.
- Platelet and hemoglobin levels decreased slightly but were not associated with adverse events.

## Abstract

Aim: The rationale for combining various extracorporeal blood purification techniques to improve patient outcomes is currently being discussed extensively. The combined use of CytoSorb®, with high capacity for cytokine removal, and Oxiris®, which adsorbs endotoxins and smaller cytokines, may enhance the efficacy of blood purification in sepsis. Study Design: Retrospective analysis of efficacy and safety of simultaneous use of CytoSorb® and Oxiris® in 12 consecutive critically ill patients with COVID-19, who developed secondary bacterial sepsis and persistent hemodynamic instability. Results: Most of the patients (n = 8) treated with combination of the Oxiris® and CytoSorb® had a significant decrease in vasopressor requirement. Pre- and post-haemoadsorption data were analysed in 9 patients, who completed a 24 h course of treatment. A significant decrease in mean SOFA score (16.3 ± 1.7 to 15.0 ± 2.0 points), median vasopressor requirement (0.56 ± 0.29 to 0.11 ± 0.21 µg/kg/min), median procalcitonin levels (6.5 ± 27.0 to 1.6 ± 6.0 ng/mL), median IL-6 levels (584 ± 6279 to 107 ± 571 pg/mL), and mean leucocyte count (36.0 ± 20.6 to 20.9 ± 10.1 × 103/mL) was observed. Furthermore, there was significant increase in PaO2/FiO2 ratio (108 ± 30 to 185 ± 55). We did not observe any device-associated adverse events or technical problems. A 27.5% drop in platelet count (269 ± 116 to 195 ± 82 × 106/mL) and an 11.8% drop in haemoglobin level (10.7 ± 2.9 to 9.5 ± 2.0 g/dL) was noted. Conclusions: Our data suggests that combined use of Oxiris® and CytoSorb® for simultaneous cytokine and endotoxin removal in patients with underlying viral infection may be a promising therapeutic option. Our findings may serve as a guide for future research and provide directions for further development in this field.