Cytosorb filter: An adjunct for survival in the COVID-19 patient in cytokine storm? a case report.
Saniya Rizvi, Michael Danic, Mark Silver and 1 others
PMID 33041058WHAT IT FOUND
A critically ill man survived severe COVID-19 ARDS after a complex ICU course that included a Cytosorb filter among many treatments.
This is a single case, not evidence the filter works.
Key findings
01The team obtained emergency IRB approval for compassionate use of a cytokine filter on hospital day 11.
02The patient received Cytosorb filter therapy with CRRT for twelve days using 8 devices at a blood flow of 200 cc/minute.
03He survived and was discharged to subacute rehab after 60 days, with tracheostomy and PEG tube support.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is one patient, not a controlled study, so it cannot show that the Cytosorb filter improved survival. He received many treatments at the same time, including ceftriaxone, azithromycin, hydroxychloroquine, piperacillin-tazobactam, vancomycin, methylprednisolone, CRRT, Cytosorb filter, ARDS Net ventilation, paralysis, prone positioning, norepinephrine, phenylephrine, epinephrine, heparin, argatroban, tocilizumab, convalescent plasma, vitamin C, zinc, tracheostomy, PEG tube feeding, sertraline, quetiapine, and blood transfusion, so the filter's contribution cannot be separated. The filter was started after severe ARDS and organ dysfunction had developed, so the suggestion that earlier use might help is not tested here. The report does not give a pre-specified outcome measure, comparison group, or long-term follow-up beyond discharge to a subacute rehab facility.
Declared interests
The authors declared no conflicts of interest. The text notes that the manufacturer assisted with installation and that treatment length followed Cytosorbents recommendations.
The easy way to misread this
Do not conclude that the Cytosorb filter caused survival. This is a single case report in which the patient received ceftriaxone, azithromycin, hydroxychloroquine, piperacillin-tazobactam, vancomycin, methylprednisolone, CRRT, Cytosorb filter, ARDS Net ventilation, paralysis, prone positioning, norepinephrine, phenylephrine, epinephrine, heparin, argatroban, tocilizumab, convalescent plasma, vitamin C, zinc, tracheostomy, PEG tube feeding, sertraline, quetiapine, and blood transfusion, and the authors state the filter was not curative.