Authors: Juvakka O et al.
Journal of Cardiothoracic and Vascular Anesthesia. Single-centre retrospective study, published 2026.
Summary
This retrospective single-centre study evaluated the impact of Oxiris® hemadsorption filter therapy on vasoplegic shock requiring continuous renal replacement therapy after cardiac surgery. Vasoplegia following cardiac surgery is a severe complication characterized by high cardiac output with profound vasodilation and heavy vasopressor requirements, potentially driven by inflammatory mediators such as endotoxins and cytokines. The authors compared Oxiris® filters to standard CRRT filters to assess whether hemadsorption improved hemodynamic stability.
Fifty-eight patients who developed vasoplegia requiring CRRT within 24 hours of cardiac surgery were included, with cardiac transplantation representing the most common surgical procedure. Patients treated with Oxiris® filters had significantly higher baseline vasoactive-inotropic scores, indicating more severe shock at CRRT initiation. Despite this, the Oxiris® group demonstrated a significantly greater reduction in vasoactive-inotropic score at 48 hours compared with controls after adjustment for baseline differences.
The observed reduction in vasoactive support was largely driven by decreased norepinephrine requirements. No significant differences were observed between groups in measured hemodynamic parameters, fluid balance, intensive care unit length of stay, or 30-day mortality. These findings suggest that while Oxiris® therapy may facilitate earlier vasopressor de-escalation, it does not clearly translate into broader short-term clinical outcome improvements in this cohort.
What You Should Know
Use of Oxiris® hemadsorption filters during CRRT was associated with greater vasopressor reduction in post-cardiac surgery vasoplegia.
The reduction in vasoactive-inotropic score was primarily driven by decreased norepinephrine requirements.
Oxiris® patients started with more severe vasoplegia yet still showed greater improvement at 48 hours.
No differences were observed in ICU length of stay or short-term mortality.
Key Points
Question: Does Oxiris® hemadsorption during CRRT improve hemodynamic stability in vasoplegic shock after cardiac surgery?
Findings: Oxiris® filter use was associated with a greater reduction in vasoactive-inotropic score and norepinephrine dose compared with standard filters.
Meaning: Hemadsorption with Oxiris® may support vasopressor de-escalation in severe post-cardiac surgery vasoplegia, though its impact on broader outcomes remains uncertain.
Thank you to the Journal of Cardiothoracic and Vascular Anesthesia for publishing this focused evaluation of hemadsorption therapy in postoperative vasoplegic shock.