CytoSorb haemoadsorption in critically ill children: a multicentre observational study on feasibility, safety, and outcomes, the CYTOPED study.

Abstract

Introduction: CytoSorb® is a cartridge for the adsorption of inflammatory mediators, bilirubin, myoglobin and other xenobiotics, directly from the blood stream. Clinical experience is widely documented in adults, whereas, in the paediatric settings, it is currently limited to single case reports or monocentric studies. In order to be able to collect evidence in larger paediatric populations, an Italian multicentre network (CYTOPED study group) was founded.

Methods: Italian multicentric observational registry on the use of CytoSorb® in critically ill paediatric patients. Prospective enrolment by Italian Children's Hospitals has been ongoing since February 2021 with a retrospective analysis conducted from February 2018 to February 2021.

Results: 62 patients have been enrolled. Median Paediatric Logistic Organ Dysfunction 2 (PELOD-2) score on Paediatric Intensive Care Unit (PICU) admission was 7 (IQR 4;10). The primary clinical indications for haemoadsorption (HA) were sepsis or septic shock (n = 36), followed by liver failure, rhabdomyolysis, cardiac surgery. CytoSorb® has been applied in 87% of cases integrated in a continuous renal replacement therapy (CRRT) circuit. The median time of HA was 48 h (IQR 26;72) and the median number of cartridges used was 2 (IQR 1;3). Anticoagulation in the extracorporeal circuit has been managed with heparin (76%) and regional citrate anticoagulation (24%). Adverse events were recorded in 12 patients.

Conclusion: Our data provide some insights into safety and feasibility of CytoSorb® therapy in children. The advancement of the study and the prospective arm of CYTOPED registry will allow further investigation into this therapy, including dosage, timing and use of antibiotics in conjunction with extracorporeal blood purification techniques.