# CytoSorb® Hemadsorption During Microaxial Flow Pump (mAFP) Support in Cardiogenic Shock: A Propensity Score-Matched Cohort Study

## TL;DR

This study suggests that adding CytoSorb hemadsorption to microaxial flow pump support may improve outcomes in patients with cardiogenic shock by reducing inflammation and improving hemodynamics.

## Contribution

The study provides new evidence on the potential benefits of CytoSorb hemadsorption as an adjunct therapy during mAFP support in cardiogenic shock.

## Key findings

- Patients with CytoSorb therapy showed significant reductions in vasoactive-inotropic score, procalcitonin, and respiratory pressures.
- Hemodynamic stabilization was observed with a significant decline in mAFP flow rates in the CytoSorb group.
- In-hospital mortality was lower in the CytoSorb group, though not statistically significant.

## Abstract

Background: Despite advances in temporary mechanical circulatory support (tMCS), patients with cardiogenic shock (CS) who are treated with a microaxial flow pump (mAFP; Impella®, Abiomed) still have a high mortality rate. A dysregulated systemic inflammatory response significantly contributes to multiorgan failure in this population. CytoSorb® hemadsorption has emerged as a potential adjunctive therapy for modulating inflammation, but data on its use in CS are limited. Methods: This retrospective, single-center study used propensity score matching analysis (1:1 matching; n = 15 per group) to compare the outcomes of patients receiving mAFP support with and without concomitant CytoSorb therapy. Baseline data (T0), including comorbidities and clinical status at ICU admission, were collected for all patients. In the CytoSorb group, data were collected at two additional time points: 24 h before the start of CytoSorb therapy (T1), and 24 h after its completion (T2). At these time points, laboratory values and parameters on respiratory, hemodynamic, and organ function were assessed. Corresponding data were also collected for matched patients in the non-CytoSorb group at equivalent time points relative to their matched counterparts. Results: In the propensity score-matched cohort, patients treated with CytoSorb exhibited significant improvements between T1 and T2. Specifically, reductions were observed in the vasoactive-inotropic score (p = 0.035), procalcitonin levels (p = 0.041), peak inspiratory pressure (p = 0.036), and positive end-expiratory pressure (p = 0.016). Flow rates through the mAFP declined significantly (p = 0.014), suggesting stabilization of hemodynamics. These changes were not observed in the non-CytoSorb group, where most parameters remained unchanged or exhibited less pronounced trends. We observed a lower in-hospital mortality rate in the CytoSorb group (33.3% versus 46.7%), though the difference was not significant, potentially due to limited statistical power. Conclusions: CytoSorb hemadsorption in mAFP-supported CS was associated with improved hemodynamic stability and reduced inflammatory burden. These findings suggest a potential therapeutic benefit of adjunctive hemadsorption in this high-risk population.