title: Evaluation of the Cytosorb™ Hemoadsorptive Column in a Pig Model of Severe Smoke and Burn Injury.
abstract: BACKGROUND
  Host inflammatory response to any form of tissue injury, including burn, trauma, or shock, has been well documented. After significant burns, cytokines can increase substantially within the first 24 h after injury and may contribute to subsequent organ failure. Hemoadsorption by cytokine-adsorbing columns may attenuate this maladaptive response, thereby improving outcomes. The aim of this study was to investigate the feasibility, technical safety, and efficacy of cytokine and myoglobin removal by early use of a cytokine absorbing column (CytoSorb) in a porcine model of smoke inhalation and burn injury.
  
  
  METHODS
  Anesthetized female Yorkshire pigs (n = 15) were injured by wood bark smoke inhalation and a 40% total body surface area deep burn and observed for 72 h or death. The animals were randomized to hemoadsorption treatment (n = 9) or a sham group (n = 6) before injury. A 6-h hemoadsorption or sham session was performed on days one, two, and three. Serum cytokines (IL-1b, IL-6, IL-8, IL-10, TNF-alpha) and myoglobin were measured systemically, locally in bronchoalveolar lavage fluid and also in circulating blood before and after the adsorbing column to evaluate single pass clearance by the device.
  
  
  RESULTS
  Hemoadsorption caused significant removal of IL-1b, IL-6, IL-10, and myoglobin across the device mainly during the first run, ranging from 22% for IL-6 to 29% for IL-1b and 41% removal rates for myoglobin after 15  min of treatment. Systemic cytokine or myoglobin serum concentrations did not change.
  
  
  CONCLUSIONS
  In a porcine model of smoke and burn injury, hemoadsorption using the CytoSorb cartridge did not result in significant systemic or pulmonary reductions in the measured cytokines or myoglobin despite efficient transmembrane reductions. Further investigations are needed to optimize the efficiency of mediator clearance to affect both circulating levels and clinically relevant outcomes.
authors.affiliation: *United States Army Institute of Surgical Research, Fort Sam Houston, Houston, Texas †University of Texas Health Science Center at San Antonio ‡San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas §Pediatric Cardiology Department, University Hospital Bonn, Bonn, Germany ¶Dipartimento di Scienze della Salute, Università degli Studi di Milano-Bicocca, Monza, Italy ||Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Linden
authors.forename: Vittorio
authors.initials: V
authors.lastname: Scaravilli
authors.forename: Stefan F X
authors.initials: SF
authors.lastname: Kreyer
authors.forename: Slava M
authors.initials: SM
authors.lastname: Belenkiy
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Stewart
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Chung
authors.forename: Leopoldo C
authors.initials: LC
authors.lastname: Cancio
authors.forename: Andriy I
authors.initials: AI
authors.lastname: Batchinsky
mesh_terms: D000818:Animals; D001992:Bronchoalveolar Lavage Fluid; D002056:Burns / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D016207:Cytokines / Q000097:blood; D004195:Disease Models, Animal; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006464:Hemoperfusion / Q000379:methods*; D009211:Myoglobin / Q000378:metabolism; D015208:Smoke Inhalation Injury / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D034421:Sus scrofa
chemical_list: D016207:Cytokines; D009211:Myoglobin