Background:

Blood purifcation through the removal of plasma solutes by adsorption to beads of charcoal or resins
contained in a cartridge (hemoperfusion) has a long and imperfect history. Developments in production and coating
technology, however, have recently increased the biocompatibility of sorbents and have spurred renewed interest in
hemoperfusion.

Methods:

We performed a narrative assessment of the literature with focus on the technology, characteristics, and
principles of hemoperfusion. We assessed publications in ex vivo, animal, and human studies. We synthesized such
literature in a technical and state-of-the-art summary.

Results:

Early hemoperfusion studies were hampered by bioincompatibility. Recent technology, however, has
improved its safety. Hemoperfusion has been used with positive efects in chronic dialysis and chronic liver disease. It
has also demonstrated extraction of a variety of toxins and drugs during episodes of overdose. Trials with endotoxin
binding polymyxin B have shown mixed results in septic shock and are under active investigation. The role of non selective hemoperfusion in sepsis or infammation remains. Although new technologies have made sorbents more
biocompatible, the research agenda in the feld remains vast.

Conclusion:

New sorbents markedly difer from those used in the past because of greater biocompatibility and
safety. Initial studies of novel sorbent-based hemoperfusion show some promise in specifc chronic conditions and
some acute states. Systematic studies of novel sorbent-based hemoperfusion are now both necessary and justifed.