Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Mar 9, 2024; 13(1): 89026
Published online Mar 9, 2024. doi: 10.5492/wjccm.v13.i1.89026
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
Yatin Mehta, Institute of Critical Care and Anesthesiology, Medanta The Medicity, Gurgaon 122001, Haryana, India
Abdul Samad Ansari, Department of Critical Care, Nanavati Max Super Specialty Hospital, Mumbai 400065, India
Amit Kumar Mandal, Department of Pulmonology, Sleep and Critical Care, Fortis Hospital, Mohali, Punjab, Mohali 160062, Punjab , India
Dipanjan Chatterjee, Department of Cardio-Puimonary Critical Care, Medica Superspecialty Hospital, Kolkata 700099, India
Gauri Shankar Sharma, Department of Critical Care Medicine, Fortis Hospital, New Delhi 110070, India
Prachee Sathe, Department of Critical Care Medicine, D.Y. Patil Medical College, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad,, Pune 411018, India
Purvesh V Umraniya, Department of Critical Care Medicine, Bhailal Amin General Hospital, Vadodara 390003, Gujarat, India
Rajib Paul, Department of Internal Medicine, Apollo Hospitals, Jubilee Hills, Hyderabad 500 033, India
Sachin Gupta, Department of Anaesthesiology, Narayana Superspeciality Hospital, Gurugram 122002, India
Vinod Singh, Department of Critical Care Medicine, Institute of Critical Care Medicine, Hospital Name - Sir Ganga Ram Hospital, New Delhi 110001, India
Yogendra Pal Singh, Department of Critical Care Medicine, Max Super Speciality Hospital, Delhi 110092, India
Author contributions: Mehta Y, Ansari A, Mandal AK, Chatterjee D, Sharma GS, Sathe P, Umraniya PV, Paul R, Gupta S, Singh VK, and Singh YP contributed to conceptualization/ideation, data analysis; contributed to writing – original draft, writing – review & editing; all the authors have equally contributed towards conceptualization/ideation, data analysis, manuscript review and final approval; all authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: All the authors declare no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yatin Mehta, DNB, MD, Chairman, Doctor, Institute of Critical Care and Anesthesiology, Medanta The Medicity, Gurgaon 122001, Haryana, India. yatinmehta@hotmail.com
Received: October 18, 2023
Peer-review started: October 18, 2023
First decision: November 23, 2023
Revised: December 5, 2023
Accepted: January 17, 2024
Article in press: January 17, 2024
Published online: March 9, 2024
Processing time: 138 Days and 13.7 Hours
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

Core Tip: This evidence-based expert consensus statement gives information/clarity on the key areas of knowledge gaps of CytoSorb® therapy: need for adjuvant therapy, initiation timeline, need for Interleukin -6 levels, duration of therapy, change of adsorbers, safety, prerequisite condition, efficacy endpoints, and (therapy) management flowchart. This expert consensus statements provides general physicians, emergency care physicians, anaesthetist, and intensivists with current information regarding the use of CytoSorb® haemoadsorption as an adjuvant treatment in patients with refractory septic shock.