Background

We sought to clarify the benefit of cytokine adsorption in patients with COVID-19 supported with venovenous extracorporeal membrane oxygenation (ECMO).

Methods

We did a single-centre, open-label, randomised, controlled trial to investigate cytokine adsorption in adult
patients with severe COVID-19 pneumonia requiring ECMO. Patients with COVID-19 selected for ECMO at the
Freiburg University Medical Center (Freiburg, Germany) were randomly assigned (1:1) to receive cytokine adsorption
using the CytoSorb device or not. Randomisation was computer-generated, allocation was concealed by opaque,
sequentially numbered sealed envelopes. The CytoSorb device was incorporated into the ECMO circuit before
connection to the patient circuit, replaced every 24 h, and removed after 72 h. The primary endpoint was serum
interleukin-6 (IL-6) concentration 72 h after initiation of ECMO analysed by intention to treat. Secondary endpoints
included 30-day survival. The trial is registered with ClinicalTrials.gov (NCT04324528) and the German Clinical Trials
Register (DRKS00021300) and is closed.

Findings

From March 29, 2020, to Dec 29, 2020, of 34 patients assessed for eligibility, 17 (50%) were treated with
cytokine adsorption and 17 (50%) without. Median IL-6 decreased from 357·0 pg/mL to 98·6 pg/mL in patients
randomly assigned to cytokine adsorption and from 289·0 pg/mL to 112·0 pg/mL in the control group after 72 h.
One patient in each group died before 72 h. Adjusted mean log IL-6 concentrations after 72 h were 0·30 higher in the
cytokine adsorption group (95% CI −0·70 to 1·30, p=0·54). Survival after 30 days was three (18%) of 17 with cytokine
adsorption and 13 (76%) of 17 without cytokine adsorption (p=0·0016).

Interpretation

Early initiation of cytokine adsorption in patients with severe COVID-19 and venovenous ECMO did
not reduce serum IL-6 and had a negative effect on survival. Cytokine adsorption should not be used during the first
days of ECMO support in COVID-19