Acute respiratory distress syndrome (ARDS) is often a consequence of a dysregulated
immune response; therefore, immunomodulation by extracorporeal cytokine removal has
been increasingly used as an adjuvant therapy, but convincing data are still missing.
The aim of this study was to investigate the effects of adjunctive hemoadsorption
(HA) on clinical and laboratory outcomes in patients with ARDS.We performed a systematic
literature search in PubMed, Embase, CENTRAL, Scopus, and Web of Science (PROSPERO:
CRD42022292176). The population was patients receiving HA therapy for ARDS. The primary
outcome was the change in PaO2/FiO2 before and after HA therapy. Secondary outcomes
included the before and after values for C-reactive protein (CRP), lactate, interleukin-6
(IL-6), and norepinephrine (NE) doses.We included 26 publications, with 243 patients
(198 undergoing HA therapy and 45 controls). There was a significant improvement in
PaO2/FiO2 ratio following HA therapy (MD = 68.93 [95%-CI: 28.79 to 109.06] mmHg, p
= 0.005) and a reduction in CRP levels (MD = -45.02 [95%-CI: -82.64; -7.39] mg/dL,
p = 0.026) and NE dose (MD = -0.24 [95%-CI: -0.44 to -0.04] μg/kg/min, p = 0.028).Based
on our findings, HA resulted in a significant improvement in oxygenation and a reduction
in NE dose and CRP levels in patients treated with ARDS. Properly designed RCTs are
still needed.
