Systematic review with expert consensus on use of extracorporeal hemoadsorption in septic shock: An Indian perspective

Yatin Mehta; Abdul Samad Ansari; Amit Kumar Mandal; Dipanjan Chatterjee; Gauri Shankar Sharma; Prachee Sathe; Purvesh V Umraniya; Rajib Paul; Sachin Gupta; Vinod Singh; Yogendra Pal Singh

doi:10.5492/wjccm.v13.i1.89026

Systematic review with expert consensus on use of extracorporeal hemoadsorption in septic shock: An Indian perspective

World J Crit Care Med. 2024 Mar 9;13(1):89026. doi: 10.5492/wjccm.v13.i1.89026.

Authors

Affiliations

¹ Institute of Critical Care and Anesthesiology, Medanta The Medicity, Gurgaon 122001, Haryana, India. yatinmehta@hotmail.com.
² Department of Critical Care, Nanavati Max Super Specialty Hospital, Mumbai 400065, India.
³ Department of Pulmonology, Sleep and Critical Care, Fortis Hospital, Mohali, Punjab, Mohali 160062, Punjab , India.
⁴ Department of Cardio-Puimonary Critical Care, Medica Superspecialty Hospital, Kolkata 700099, India.
⁵ Department of Critical Care Medicine, Fortis Hospital, New Delhi 110070, India.
⁶ Department of Critical Care Medicine, D.Y. Patil Medical College, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad,, Pune 411018, India.
⁷ Department of Critical Care Medicine, Bhailal Amin General Hospital, Vadodara 390003, Gujarat, India.
⁸ Department of Internal Medicine, Apollo Hospitals, Jubilee Hills, Hyderabad 500 033, India.
⁹ Department of Anaesthesiology, Narayana Superspeciality Hospital, Gurugram 122002, India.
¹⁰ Department of Critical Care Medicine, Institute of Critical Care Medicine, Hospital Name - Sir Ganga Ram Hospital, New Delhi 110001, India.
¹¹ Department of Critical Care Medicine, Max Super Speciality Hospital, Delhi 110092, India.

Abstract

Background: Septic shock is a severe form of sepsis characterised by deterioration in circulatory and cellular-metabolic parameters. Despite standard therapy, the outcomes are poor. Newer adjuvant therapy, such as CytoSorb^® extracorporeal haemoadsorption device, has been investigated and shown promising outcome. However, there is a lack of some guidance to make clinical decisions on the use of CytoSorb^® haemoadsorption as an adjuvant therapy in septic shock in Indian Setting. Therefore, this expert consensus was formulated.

Aim: To formulate/establish specific consensus statements on the use of CytoSorb^® haemoadsorption treatment based on the best available evidence and contextualised to the Indian scenario.

Methods: We performed a comprehensive literature on CytoSorb^® haemoadsorption in sepsis, septic shock in PubMed selecting papers published between January 2011 and March 2023 2021 in English language. The statements for a consensus document were developed based on the summarised literature analysis and identification of knowledge gaps. Using a modified Delphi approach combining evidence appraisal and expert opinion, the following topics related to CytoSorb^® in septic shock were addressed: need for adjuvant therapy, initiation timeline, need for Interleukin -6 levels, duration of therapy, change of adsorbers, safety, prerequisite condition, efficacy endpoints and management flowchart. Eleven expert members from critical care, emergency medicine, and the intensive care participated and voted on nine statements and one open-ended question.

Results: Eleven expert members from critical care, emergency medicine, and the intensive care participated and voted on nine statements and one open-ended question. All 11 experts in the consensus group (100%) participated in the first, second and third round of voting. After three iterative voting rounds and adapting two statements, consensus was achieved on nine statements out of nine statements. The consensus expert panel also recognised the necessity to form an association or society that can keep a registry regarding the use of CytoSorb^® for all indications in the open-ended question (Q10) focusing on "future recommendations for CytoSorb^® therapy".

Conclusion: This Indian perspective consensus statement supports and provides guidance on the use of CytoSorb^® haemoadsorption as an adjuvant treatment in patients with septic shock to achieve optimal outcomes.

Keywords: Consensus; CytoSorb; Cytokine; Hemoadsorption; Refractory; Sepsis; Septic shock.