®

CytoSorb Therapy
Indications and set-up
 CytoSorb Therapy
REGAIN CONTROL

The statements in this document do not constitute a diagnostic or therapeutic

recommendation. It is a “best practice” collection, based on the current level of knowledge and
expert opinion. The indication, conduction and termination of the CytoSorb Therapy is in the
responsibility of the treating physician. The short set-up guide does not replace the instructions
for use.
 Table of contents

The Therapy | 01

Indications
Sepsis / Septic shock | 02
Cardiac surgery intraoperative | 03
Cardiac surgery postoperative | 04

Set-up
Short user guide | 05
CytoSorb as stand-alone therapy | 06
CytoSorb combined with renal replacement therapy | 07
CytoSorb in cardiopulmonary bypass | 08

3
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4
01|
01|TheThe
Therapy
Therapy

02|
02| Sepsis
Sepsis
Septic
Septic
shock
shock

03|
03|Cardiac
Cardiac
surgery
surgery
intraoperative
intraoperative

04|
04|Cardiac
Cardiac
surgery
surgery
postoperative
postoperative
 The Therapy
01| The Therapy
 The Therapy

The CytoSorb Therapy is based on potentially be avoided. Stabilization

an extracorporeal blood purification following a hyperinflammatory phase
that effectively reduces excessive could be improved.
level of inflammatory mediators.

In doing so, the goal is to reduce the

overshooting systemic inflammatory
response while the physiologic
immune response is maintained.

Patients with hyperinflammatory in-

fectious and non-infectious conditions
should benefit from a CytoSorb therapy.

The life-threatening complications of

the so called cytokine storm could

8
 The Therapy

This is how CytoSorb modulates the immune response

• Effective reduction of excessive cytokine levels
• Decreased de novo synthesis of inflammatory mediators
• Controlled attenuation of the overshooting immune response
• Re-targeting of the cellular immune defense to the focus of infection

Your CytoSorb Therapy goals

• Control the systemic inflammation
• Modulate the immune response
• Stabilize hemodynamics
• Improve the fluid balance
• Prevent and treat organ dysfunction and organ failure

9
 The Therapy

Proprietary polymer technology

20cm

Whole blood
Blutfluss
Section through adsorber Adsorber bead Internal structure

• High-tech polymer • Blood flow 150-500 ml/min

• Size selectivity < 55 kD • Pre-filled with isotonic saline
• Low flow resistance solution
• Blood volume 120 ml • Gamma sterilized, 3 years shelf life

10
02|

Septic shock
Sepsis

Sepsis /
Septic shock
Sepsis / septischer Schock

Grundvoraussetzungen

• Beginnende oder andauernde akute Entzündungsphase

• Standardtherapie gemäß Sepsis-Leitlinien durchgeführt
(z. B. 6 Std. Sepsis-Bundle, Fokuskontrolle)
• APACHE II > 25, Thrombozyten > 20.000/μl, keine DNR-Order
• CytoSorb ist als Begleittherapie, nicht als kausale Therapie einzusetzen
• Organversagen eher verhindern als behandeln: irreversibler Zellschädigung
und Zelltod zuvorkommen
• Kontinuierliche Behandlung gegenüber intermittierender vorzuziehen
• Blutflussrate zwischen 200-400ml/min
• Antikoagulation im extrakorporalen Kreislauf empfohlen mit Heparin oder
Zitrat, Ziel aPTT 60 – 80 Sek.
• Im Hämoperfusionsmodus ausschließlich Heparin-Antikoagulation
• Kontraindikationen für extrakorporale Blutkreisläufe beachten

Organversagen eher verhindern als behandeln:

irreversibler Zellschädigung und Zelltod zuvorkommen
siehe Aufbauschema Seite xx
siehe Aufbauschema Seite xx
 Sepsis / Septic shock

Basic prerequisites
• Onset of or ongoing acute systemic hyperinflammation
• Standard therapy according to sepsis guidelines established
(e.g. 6 hr sepsis bundle, focus control)
• APACHE II > 25, platelets > 20.000/μl, no DNR order
• CytoSorb is to be employed as adjunctive, not as causative therapy

• Treatment duration and indication for exchange of adsorber depend on

the clinical course, maximum treatment time per adsorber 24 hours
• Continuous treatment is recommended over intermittent one
• Typical blood flow rate 150 – 500 ml/min
• Anticoagulation with heparin or citrate, aPTT of 60 – 80 sec is sufficient
for CytoSorb
• With stand-alone mode heparin anticoagulation only
• Contraindications for extracorporeal blood circuits apply

 see set-up page 32 ff.

13
 Sepsis / Septic shock

When should the therapy be started?

• Patient cannot be stabilized clinically with standard
medical treatment
• Clinical picture of hyperinflammation
- Onset of shock (Norepinephrine > 0,3 μg/kg/min or rapidly increasing)
within the last 24 hrs
- Signs of capillary leak – e.g. positive fluid balance
• Development of at least one more organ dysfunction
- Kidney, lung, liver, coagulation, neurologic impairment
• Systemic markers of infection:
- PCT > 3 ng/l in case of bacterial or fungal sepsis
- High IL-6 levels (e.g. >500 pg/ml) can, if available, support the treatment
decision, but low levels do not preclude reasonableness of treatment

Early start of therapy:

Rather
sieheavoid than treat Seite
Aufbauschema organxxfailure.

14
 Sepsis / Septic shock

Why start early?

• Pre-clinical data and previous clinical experience hint at survival benefit if

CytoSorb Therapy is started early (1- 4)
• The guidelines, that are based on sound clinical evidence, should be
followed first
• CytoSorb should be started if patients do not respond sufficiently to
guideline therapeutic recommendations
• Insufficient therapeutic efficacy of the sepsis bundle is the recommended
indication for start of CytoSorb Therapy in septic shock

References
1. Peng ZY et al, Kidney Int. 2012 Feb;81(4):363-9 3. Hetz H et al, Int J Artif Organs. 2014 May;37(5):422-6
2. Peng ZY et al, Crit Care Med. 2008 May;36(5):1573-7 4. Sathe P et al, Critical Care 2015, 19(Suppl 1): P130

Organ dysfunction caused by inflammation is potentially reversible

and can be treated, in contrast to irreversible organ cell failure.

15
 Sepsis / Septic shock

Signs of a successful CytoSorb Therapy

• Stabilization of the hemodynamic situation

- Decreasing vasopressor need
- Less positive or stabilization of fluid balance
- No further increase of lactate level

• Decrease of IL-6 level (if measured) and of WBC, PCT, CRP

- When assessing the course of PCT, be aware of direct,
partial PCT removal by CytoSorb

• Stabilization of other organ functions, e.g.

- No further deterioration of liver function parameters
- No further increase of ventilatory support necessary
- Improvement of coagulation situation

16
 Sepsis / Septic shock

When should the therapy be terminated?

• Treatment should be continued until clinical condition indicates

that systemic hyperinflammation is under control
- No need of catecholamines or rapidly decreasing dosage
- Reversal of fluid balance, reduction of edema
- Normalization of lactate level

• Improvement of impaired organ functions, e.g.

- Marked reduction of ventilatory support
- Return of spontaneous diuresis
- Improvement of liver function parameters

• Deterioration after cessation of CytoSorb treatment (e.g. insufficient focus

control or second hit) may indicate necessity to recommence CytoSorb
Therapy

17
 Sepsis / Septic shock

Possible patient groups

• Post-surgical patients with severe sepsis and onset of AKI

• Patients with severe concomitant diseases and impaired immune
competence
- Often elderly patients
- Chronic diseases:
• Chronic dialysis patients
• Patients with chronic liver disease
• Patients with therapy refractory septic shock and multi-organ failure
• Patients suffering from sepsis boosted by enterotoxins
• Patients with hyperinflammation in viral and fungal sepsis or in tropical
diseases

18
03| Cardiac surgery
intraoperative

Cardiac surgery
intraoperative
Cardiac surgery: Intraoperative use

Basic prerequisites
• Installation never into the mainstream of a
cardiopulmonary bypass (CPB)
• Typical blood flow rate 150 – 500 ml/min
• Anticoagulation with heparin, ACT of 160 - 210 sec
is sufficient for CytoSorb

 see set-up page 52

 Cardiac surgery: Intraoperative use

When should the therapy be started?

At the start of CPB
Preemptive use in case of one or more of the following risk factors:
• Age > 75 yrs
• Preoperative activation of the immune system:
- Endocarditis
- Cardiac failure with inotropic therapy
- Preoperative leukocytosis (> 12,000/μl)
- Organ dysfunctions, e.g. kidney or liver
• Procedures with higher risk for complications and/or SIRS
- Combination procedures (valve repair/-replacement, CABG)
- Redo procedures
- Aortic surgery with hypothermic circulatory arrest
- LVAD implant
• Long CPB duration expected (>120 min)
• High risk for postoperative need for ECMO

Anytime during CPB

Patients with low primary risk but unexpected course
• Unexpected, significant prolongation of anticipated CPB time
• Intraoperative development of a severe SIRS
• Intraoperative complications with expected development of severe SIRS
21
 Cardiac surgery: Intraoperative use

When should the therapy be terminated?

At the end of CPB in case of preemptive use and 
• Uneventful intraoperative course
• No signs of hyperinflammation at end of CPB
• No undue hemodynamic instability at end of CPB

Postoperative continuation on ICU in case of 

• Ongoing or beginning SIRS intraoperatively
• Severe SIRS to be expected postoperatively

22
04| Cardiac surgery
postoperative

Cardiac surgery
postoperative
 Cardiac
Cardiac
surgery:
surgery:
Postoperative
Postoperative
useuse

Basic
Basic
prerequisites
prerequisites
is based on potentially be avoided. Stabilization
• Onset
d purification • Onset
of or ongoing
of or aongoing
following acute acute
systemic
hyperinflammatorysystemic
hyperinflammation
hyperinflammation
phase
• Standard
• Standard
therapytherapy
established
established
and optimized
and optimized
es excessive could be improved.
• Platelets
• Platelets
> 20.000/μl,
> 20.000/μl,
no DNR no order
DNR order
y mediators.
• In case
• In of
case
sepsis,
of sepsis,
CytoSorbCytoSorb
is to be
is to
employed
be employedas adjunctive,
as adjunctive,
not asnot as
causative
causative
therapytherapy
to reduce the
inflammatory • Treatment
• Treatment duration
duration and indication
and indication for exchange
for exchange of adsorber
of adsorber depend depend
on theon the
clinical
physiologic clinical
course,course,
maximummaximumtreatment
treatment
time per
timeadsorber
per adsorber
24 hours
24 hours
• Continuous
maintained. • Continuous
treatment
treatment
is recommended
is recommended over intermittent
over intermittent
one one
• Typical
• Typical
bloodblood
flow rate
flow150rate– 150
500 –ml/min
500 ml/min
ammatory• Anticoagulation
in-• Anticoagulationwith heparin
with heparin
or citrate,
or citrate,
aPTT aPTT
of 60 of
– 80
60sec
– 80issec
sufficient
is sufficient
for for
CytoSorb
CytoSorb
ous conditions
• With • stand-alone
With stand-alonemodemodeheparin heparin
anticoagulation
anticoagulation
only only
oSorb therapy.
• Contraindications
• Contraindicationsfor extracorporeal
for extracorporeal
bloodblood
circuits
circuits
apply apply
mplications of
Early Early
start of therapy:
start of therapy:
storm Rather
couldRather
avoidavoid
than treat
than organ failure.
treat organ failure.
siehe siehe
Aufbauschema
Aufbauschema
Seite Seite
xx xx
24
Seeset-up
 24 page 32
See set-up ff. 32 ff.
page
 Cardiac surgery: Postoperative use

When should the therapy be started?

Immediately upon arrival in ICU
• Postoperative continuation of intraoperative CytoSorb treatment
• Manifest severe SIRS upon arrival
Postoperative (0-48h) development of SIRS with or without proof of infection
• Patient cannot be stabilized clinically with standard medical treatment
• Impaired hemodynamics (shock)
- Onset of shock (Norepinephrine > 0,3μg/kg/min or rapidly increasing)
- Signs of capillary leak – e.g. positive fluid balance
• Onset of at least one more organ dysfunction, e.g.
- Mechanical ventilation
- Acute kidney failure with need for RRT
• Systemic markers of infection:
- PCT > 3ng/l in case of bacterial or fungal sepsis
- High IL-6 levels (e.g. > 500 pg/ml) can, if available, support the treatment
decision, but low levels do not preclude reasonableness of treatment

25
 Cardiac surgery: Postoperative use

In case of sepsis - why start early?

• Pre-clinical data and previous clinical experience hint at survival

benefit if CytoSorb Therapy is started early (1 – 4)
• The guidelines, that are based on sound clinical evidence, should
be followed first
• CytoSorb should be started if patients do not respond sufficiently
to guideline therapeutic recommendations
• Insufficient therapeutic efficacy of the sepsis bundle is the recommended
indication for start of CytoSorb Therapy in septic shock

References
1. Peng ZY et al, Kidney Int. 2012 Feb;81(4):363-9 3. Hetz H et al, Int J Artif Organs. 2014 May;37(5):422-6
2. Peng ZY et al, Crit Care Med. 2008 May;36(5):1573-7 4. Sathe P et al, Critical Care 2015, 19(Suppl 1): P130

Organ dysfunction caused by inflammation is potentially reversible and

can be treated, in contrast to irreversible organ cell failure.

26
 Cardiac
Cardiac surgery:
surgery: Postoperative
Postoperative use
use

Signs
Signs of
of a
a successful
successful CytoSorb
•• Stabilization
CytoSorb Therapy
Therapy 
Stabilization of of hemodynamic
hemodynamic situation
situation
-- Decreasing
Decreasing vasopressor need
vasopressor need
-- Less
Less positive
positive or
or stabilization
stabilization of
of fluid
fluid balance
balance
-- No
No further
further increase
increase of
of lactate
lactate level
level
•• Decrease
Decrease ofof IL-6
IL-6 level
level (if
(if measured)
measured) and
and of
of WBC,
WBC, PCT
PCT (in
(in case
case of
of sepsis),
sepsis),
CRP
CRP
-- When
When assessing
assessing thethe course
course of
of PCT,
PCT, be
be aware
aware of
of direct,
direct, partial
partial PCT
PCT
removal
removal by
by CytoSorb
CytoSorb
•• Stabilization
Stabilization of of other
other organ
organ functions,
functions, e.g.
e.g.
-- NoNo further
further deterioration
deterioration of
of liver
liver function
function parameters
parameters
-- No
No further
further increase
increase of
of ventilatory
ventilatory support
support necessary
necessary
-- Improvement
Improvement of of coagulation
coagulation situation
situation

27
27
 Cardiac surgery: Postoperative use

When should the therapy be terminated?

• Treatment should be continued until clinical condition indicates that

systemic hyperinflammation is under control
- No need of catecholamines or rapidly decreasing dosage
- Reversal of fluid balance, reduction of edema
- Normalization of lactate level
• Improvement of impaired organ functions, e.g.
- Marked reduction of ventilatory support
- Return of spontaneous diuresis
- Improvement of liver function parameters
• Deterioration after cessation of CytoSorb treatment (e.g. insufficient focus
control or second hit) may indicate necessity to recommence CytoSorb
Therapy

28
05|
05| Short
Shortuser
user
guide
guide

06|
06| CytoSorb
CytoSorbasas
stand-alone
stand-alone
therapy
therapy

07|
07| CytoSorb
CytoSorb
renal
renal
combined
combined
replacement
replacement
with
with
therapy
therapy

08|
08| CytoSorb
CytoSorbin in
cardiopulmonary
cardiopulmonary
bypass
bypass
 Short user guide
05|
Set-up:
Short user guide
 Short user guide

Notes prior to treatment start

• Preparation and use of CytoSorb must always be carried out under hygienic
conditions
• Before connecting CytoSorb the supply tubing system must be airlessly pre-
filled with sterile isotonic saline solution
• Under no circumstances must air enter CytoSorb
• Always pay attention to the prescribed running direction when installing
CytoSorb
• The blood flow rate should be 150-500 ml/min
• The maximum duration of usage of a CytoSorb adsorber should not exceed
24 hours
• It may be advisable to change the adsorber sooner if there is evidence of an
exhausted elimination capacity
• Check the extracorporeal circuit at regular intervals for signs of blood clots,
the secure fit of the connections and air within the circuit

32
 Short
Shortuser
userguide
guide

Anticoagulation
Anticoagulation
• • Anticoagulation
Anticoagulationmust mustbebeeffective
effectiveatattreatment
treatmentstart
start
• • InInintensive
intensivecare
carepatients
patientsananaPTT
aPTTofof6060toto8080sec.,
sec.,when
whenusing
usingduring
during
heart
heartsurgery
surgeryananACT
ACTofof160
160toto210
210seconds,
seconds,isissufficient
sufficientfor
forCytoSorb.
CytoSorb.
Specifications
Specificationsofofthethedevice
devicemanufacturer
manufacturerhave havetotobe
beobserved
observed
• • The
TheaPTT
aPTTand
andACTACTshould
shouldbebechecked
checkedregularly
regularlyduring
duringtherapy
therapytotoensure
ensure
adequate
adequateanticoagulation
anticoagulation

General
Generalmaterials
materialsrequired:
required:
• • CytoSorb
CytoSorbadsorber
adsorber
• • Mounting
Mountingholder
holderfor
forCytoSorb
CytoSorb
• • 6 6scissor
scissorclamps
clamps
• • Isotonic
Isotonicsaline
salinesolution
solutionwith
withLuer
LuerLock
Lockfor
forflushing
flushing
(2l(2lNaCl
NaCl0.9%,
0.9%,sterile)
sterile)

3333
 Your notes

34
06|

stand-alone
Set-up:

therapy
CytoSorb as
stand-alone therapy
 CytoSorb as stand-alone therapy

Set-up
1. Set-up the device according to the manufacturer's instructions (dry)
2. Mount CytoSorb vertically into holder
3. Start blood pump and deaerate arterial tubing system
4. Stop blood pump and clamp arterial tubing system at by using scissors
clamp
5. Only remove the port plug on the CytoSorb inlet (bottom)
6. Connect CytoSorb bubble-free with arterial tubing system (observe flow
direction)
7. Now remove the blood outlet port plug (top) and connect CytoSorb
with venous tubing system
8. Remove scissor clamp from arterial tubing system
9. Start blood pump (approx. 200 ml/min) and rinse system with 2 liters of
saline solution
10. Remove CytoSorb from the holder and deaerate it by tapping
11. Start patient treatment according to manufacturer's instructions

36
 Set-up

blood pump
bubble
catcher

venous
tubing system
arterial
blood to patient
tubing system
blood from pump

37
 Your notes

38
07|
Set-up:
CytoSorb combined with
renal replacement therapy

renal replacement
 CytoSorb combined with renal replacement therapy

Set-up 1 of 2
1. Completely prepare the device according to manufacturer's instructions
(incl. flushing). If necessary during ongoing renal replacement therapy first
interrupt the treatment (return blood and disconnect patient according to
the manufacturer's instructions of each device)
2. Connect saline solution with A , deaerate and close red tubing clamp of A
3. Connect bubble-free with CytoSorb blood inlet (bottom)
(observe flow direction)
4. Connect CytoSorb blood outlet (top) with E , B , C and D
5. Open red tube clamp of A and rinse CytoSorb by gravity with 2 liters of
saline and deaerate it by tapping
6. Close red tube clamp of A and blue tube clamp of C

Continued on next page …

40
 Set-up before dialyzer
Additional materials:
Priming adapter 1
saline
solution 2l A Red Luer Lock – red DIN Lock
Color neutral DIN Lock – color
B neutral DIN Lock
C Blue DIN Lock – blue Luer Lock
E D 2l empty bag

Adapter 1
E Color neutral DIN Lock –
A color neutral DIN Lock

41
 CytoSorb combined with renal replacement therapy

Set-up 2 of 2
7. Stop blood pump
8. Clamp all tubes at the dialyzer at by use of scissor clamps
9. Disconnect A from CytoSorb blood inlet (bottom) and discard it
10. Disconnect arterial blood tube from dialyzer blood inlet and connect
bubble-free with CytoSorb blood inlet (bottom)
11. Disconnect B from E and discard B , C and D
12. Connect E bubble-free with dialyzer blood inlet
13. Remove all scissor clamps at
14. Start patient treatment according to manufacturer‘s instructions

42
 Set-up before dialyzer

blood pump E

dialyzer
bubble
catcher

arterial
tubing system
blood from pump
venous tubing
system
blood to patient
possible configuration

43
 CytoSorb combined with renal replacement therapy

Set-up 1 of 2
1. Completely prepare the device according to manufacturer‘s instructions
(incl. flushing). If necessary during ongoing renal replacement therapy first
interrupt the treatment (return blood and disconnect patient according to
the manufacturer‘s instructions of each device)
2. Connect saline solution with A and B , deaerate and close red tubing
clamp of A
3. Connect B bubble-free with CytoSorb blood inlet (bottom) (observe flow
direction)
4. Connect CytoSorb blood outlet (top) with C , D and E
5. Open red tube clamp of A and rinse CytoSorb by gravity with 2 liters of
saline and deaerate it by tapping
6. Close red tube clamp of A and blue tube clamp of B . Clamp B
before and C after CytoSorb at by using scissor clamps

Continued on next page …

44
 Set-up after dialyzer
Additional materials:
saline
solution 2l D Priming adapter 2
A Red Luer Lock – red Luer Lock
B
D Blue Luer Lock – blue Luer Lock
E 2l empty bag
Adapter 2
C Color neutral Luer Lock –
B color neutral DIN Lock
A
Color neutral DIN Lock –
C blue Luer Lock

45
 CytoSorb combined with renal replacement therapy

Set-up 2 of 2
7. Stop blood pump
8. Clamp blood tubes at the dialyzer blood outlet F and before the venous
bubble catcher G at by use of scissor clamps
9. Disconnect saline solution and A from B and discard it
10. Connect B with blood tube from dialyzer blood outlet F
11. Connect C from CytoSorb blood outlet (top) with line to venous bubble
catcher G
12. Remove all scissor clamps at
13. Start patient treatment according to manufacturer‘s instructions

Cave: If CytoSorb gets integrated after a dialyzer, postdilution in combination

with a low blood flow may lead to clotting. Predilution configuration is
recommended in this setting.

46
 Set-up after dialyzer

F B C G

blood pump

venous
bubble
dialyzer catcher

arterial
tubing system
blood from pump

venous
tubing system
possible configuration blood to patient

47
 CytoSorb exchange

1. Prepare CytoSorb according to instructions for installation before or after dialyzer

2. Interrupt ongoing treatment (return blood and disconnect patient according to
manufacturer`s instructions of each device)
3. Stop blood pump
4. Clamp blood tubes directly before and after the used CytoSorb by using scissor
clamps at
5. Disconnect flushing tube A from blood inlet of the fresh CytoSorb (bottom) and
discard it
6. Remove the supply tubing system C from the blood inlet of the used CytoSorb
(bottom) and connect it to the blood inlet of the fresh CytoSorb (bottom)
7. Close the blood inlet of the used CytoSorb with the port plug of the fresh CytoSorb
8. Disconnect the flushing tube B from the blood outlet of the fresh CytoSorb (top)
and discard it
9. Disconnect the return tubing system D from the used CytoSorb (top) and connect
it to the blood outlet of the fresh CytoSorb (top)
10. Close the blood outlet of the used CytoSorb with the port plug of the fresh CytoSorb
11. Remove scissor clamps at
12. Continue patient treatment according to manufacturer`s instructions

48
 CytoSorb exchange

return tubing system

blood to the patient

B
D
used

C fresh
A

supply tubing system

blood from pump
49
 Your notes

50
08|
Set-up:
CytoSorb in
cardiopulmonary bypass

cardiopulmonary
bypass
 CytoSorb in cardiopulmonary bypass

Set-up 1 of 2
1. Completely prepare the device according to manufacturer's instructions
(incl. flushing)
2. Connect saline solution with A , deaerate and clamp with roller clamp B
3. Connect bubble-free with CytoSorb blood inlet (bottom)
(observe flow direction)
4. Connect CytoSorb blood outlet (top) with C and D
5. Open roller clamp B and and rinse CytoSorb by gravity with 2 liters
of saline solution and deaerate it by tapping
6. Close clamps at B and D

Continued on next page …

52
 CytoSorb in cardiopulmonary bypass
Additional materials:
Adapter 3
saline
solution 2l A Color neutral Luer Lock – Color neu-
tral DIN Lock with roller clamp B
C Color neutral DIN Lock – Color
neutral Luer Lock
D 2l empty bag
E High-flow three-way valve
C
A

53
 CytoSorb in cardiopulmonary bypass

Set-up 2 of 2
7. Vertically install CytoSorb at the heart-lung-machine by using the holder
8. 2. Disconnect A from the saline bag and connect it bubble-free to a Luer Lock
F on the blood line after the pump by use of a three-way high flow valve E .
9. Connect C via a Luer Lock connection to the reservoir G
10. If necessary, regulate the flow via roller clamp B

NOTES
• For safety reasons, the installation of CytoSorb in cardiopulmonary bypass
is always carried out via a Luer lock branch between the pump and oxygenator,
forming a reflux to the reservoir
• Due to the diameter of the Luer lock connection the blood flow through
CytoSorb is limited to 400 to 500 ml/min
• In order to avoid clotting, a continuous blood flow has to be ensured after
start of the CytoSorb therapy

54
 CytoSorb in cardiopulmonary bypass

reservoir* G C

blood pump
blood line

E
oxygenator*
A
* exemplary presentations B 55
 Your notescombined with renal replacement therapy
CytoSorb

Set-up 2 of 2
7. Stop blood pump
8. Clamp blood tubes at the dialyzer blood outlet F and before the venous
bubble catcher G at by use of scissor clamps
9. Disconnect saline solution and A from B and discard it
10. Connect B with blood tube from dialyzer blood outlet F
11. Connect C from CytoSorb blood outlet (top) with line to venous bubble
catcher G
12. Remove all scissor clamps at
13. Start patient treatment according to manufacturer‘s instructions

Cave: If CytoSorb gets integrated after a dialyzer, postdilution in combination

with a low blood flow may lead to clotting. Predilution configuration is
recommended in this setting.

46
50
 ®

SIRS and Sepsis

REGAIN CONTROL

CytoSorb and CytoSorbents are trade marks of the CytoSorbents Corporation, USA. B1031R01EN2016 © Copyright 2015, CytoSorbents Europe GmbH. All rights reserved.

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