Extracorporeal hemadsorption versus glucocorticoids during cardiopulmonary bypass: a prospective, randomized, controlled trial

Introduction Cardiopulmonary bypass (CPB) surgery initiates systemic inflammatory response syndrome, which in 2-10% of all cases can be considerably severe. This complex chain of events might contribute to the development of postoperative complications. Different therapeutic interventions that can reduce inflammatory reactions during CPB have been used, in hope for improvement of patient outcome after open-heart surgery. Extracorporeal hemadsorption might reduce the inflammatory reaction in CPB surgery. Glucocorticoids, on the other hand, have been used for years during open-heart surgery for alleviation of systemic inflammation after CPB. We compared intraoperative hemadsorption and methylprednisolone, with usual care, during complex cardiac surgery on CPB, for inflammatory responses, hemodynamics, and perioperative course. Methods Seventy-six patients with prolonged CPB were recruited and randomized, with 60 included in the final analysis. The allocation was into three groups: Methylprednisolone group (n=20; 1g of methylprednisolone added in CPB priming solution), Cytosorb group (n=20; CytoSorb® adsorber, Cytosorbents Europe GmbH, Germany, installed in CPB circuit), and Control group (n=20, usual care, neither methylprednisolone nor CytoSorb® during CPB). Pro-inflammatory (TNF-a, IL-1b, IL-6, IL-8) and anti-inflammatory (IL-10) cytokines, complement C5a, CD64 and CD163 expression by immune cells were analyzed within the first five postoperative days, in addition to hemodynamic and clinical outcome parameters. Results Methylprednisolone group, compared to Cytosorb and Control, had significantly lower levels of TNF-a (until end of the surgery, p Discussion In this clinical trial, we have confirmed that intraoperative use of a median dose of methylprednisolone during CPB more effectively ameliorates systemic inflammatory responses after adult cardiac surgery. This is seen by reductions in pro-inflammatory and increases in anti-inflammatory mediators when compared to both uses of CytoSorb® adsorber for hemadsorption and usual treatment (Control). However, methylprednisolone did not provide better short-term clinical outcome. Hemadsorption itself, compared with usual care, caused higher prolonged expression of CD64 on monocytes and higher expression of CD163 on granulocytes, which only lasted until end of surgery. The use of CytoSorb® adsorber seems to be safe and well-tolerated. We haven't observed an association between its application and significant thrombocytopenia or more significant decrease in albumin concentration.