• Alexander Supady, Timm Zahn, Moritz Kuhl, Sven Maier, Christoph Benk, Klaus Kaier, Bernd W Böttiger, Christoph Bode, Achim Lother, Dawid L Staudacher, Tobias Wengenmayer, and Daniel Duerschmied.
• Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Germany; Heidelberg Institute of Global Health, University of Heidelberg, Germany. Electronic address: alexander.supady@uniklinik-freiburg.de.
• Resuscitation. 2022 Apr 1; 173: 169-178.

AimTo investigate the effect of cytokine adsorption in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) after cardiac arrest.MethodsCYTER was a single-centre, open-label, randomised, controlled trial. Patients selected for ECPR at the University Medical Center Freiburg (Freiburg, Germany) were assigned to extracorporeal membrane oxygenation (ECMO) support with or without cytokine adsorption (1:1) using the CytoSorb adsorber, incorporated into the ECMO, replaced every 24 hours, and removed after 72 hours. The primary endpoint was serum interleukin (IL)-6 concentration at 72 hours (intention-to-treat analysis). Secondary endpoints included 30-day survival, vasopressor support and biomarkers of end-organ injury.ResultsOf 50 patients enrolled in the trial, 26 (52%) were treated with cytokine adsorption and 24 (48%) without. Nine patients were excluded (informed consent could not be obtained); 41 patients were therefore included in the primary analysis. Median IL-6 levels (IQR) decreased from 408.0(93.4-906.5) to 324.0 (134.3-4617.3) pg/mL and increased from 133.0 (56.2-528.5) to 241.0 (132.8-718.0) pg/mL in the cytokine adsorption and control group, respectively (linear regression for treatment [cytokine adsorption vs control]: p = 0.48). Three (14%) of 22 patients treated with cytokine adsorption and 8 (42%) of 19 patients treated without cytokine adsorption survived to day 30 (HR = 1.85, 95% CI 0.86-4.01; p = 0.10). Vasopressor support and NSE, S100b, troponin T, CRP and PCT levels were similar between groups.ConclusionCytokine adsorption in patients receiving ECPR did not reduce serum IL-6 and had no significant effect on survival, vasopressor support, or biomarkers of injury.Clinical Trial RegistrationClinicalTrials.gov: NCT03685383.Copyright © 2022 Elsevier B.V. All rights reserved.

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