Trial reportThe Lancet. Respiratory medicine2021
Cytokine adsorption in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation (CYCOV): a single centre, open-label, randomised, controlled trial.
Trial report in The Lancet. Respiratory medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT04324528 (Cytokine Adsorption in Severe COVID-19 Pneumonia Requiring Extracorporeal Membrane Oxygenation), which is not on this map. Cited by 108 papers, 8 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Cytokine Adsorption in Severe COVID-19 Pneumonia Requiring Extracorporeal Membrane Oxygenation
Who cites it
108 citing papers in PubMed, 8 syntheses or guidelines pooled it, 195 citations in OpenAlex.
- Hemoperfusion during extracorporeal membrane oxygenation: an updated systematic review and meta-analysis of 8,151 patients.Critical care (London, England) · 2026Pooled it
- Hemoadsorption in acute respiratory distress syndrome patients requiring venovenous extracorporeal membrane oxygenation: a systematic review.Respiratory research · 2024Pooled it
- Efficacy of CytoSorb®: a systematic review and meta-analysis.Critical care (London, England) · 2023Pooled it
- Hemoadsorption in Heart Failure Requiring Mechanical Circulatory Support-A Systematic Review and Meta-Analysis.Reviews in cardiovascular medicine · 2023Pooled it
- CytoSorb in patients with coronavirus disease 2019: A rapid evidence review and meta-analysis.Frontiers in immunology · 2023Pooled it
- Mortality and adverse events of hemoadsorption with CytoSorb® in critically ill patients: A systematic review and meta-analysis of randomized controlled trials.Acta anaesthesiologica Scandinavica · 2022Pooled it
- The Fragility of Statistically Significant Results in Randomized Clinical Trials for COVID-19.JAMA network open · 2022Pooled it
- Hemoperfusion and blood purification strategies in patients with COVID-19: A systematic review.Artificial organs · 2021Pooled it
- Clinical and Immunologic Effects of Extracorporeal Cytokine Removal in Patients with Septic Shock: A Randomized Controlled Trial.Shock (Augusta, Ga.) · 2026Trial
- Safety and efficacy of the Seraph® 100 Microbind® Affinity Blood Filter to remove bacteria from the blood stream: results of the first in human study.Critical care (London, England) · 2022Trial
- Trial
- [Extracorporeal immunomodulation in sepsis : Role, limits, and perspectives of adjuvant blood purification therapies].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2026Review
- The NLRP3 inflammasome in physiological and dysfunctional host response in human sepsis and critical illness: a narrative review.Critical care (London, England) · 2026Review
- Review
- Timing of hemoadsorption in sepsis: redefining early through mediator-guided therapy.Journal of intensive care · 2026Review
- AKI as a systemic syndrome and its impact on other organ systems.Critical care (London, England) · 2026Review
- Novel extracorporeal therapies in children.Pediatric nephrology (Berlin, Germany) · 2026Article
- The role of hemoadsorption in septic shock: toward a personalized approach.Critical care (London, England) · 2026Review
- Cytokine storm in acute respiratory distress syndrome.Journal of intensive medicine · 2026Review
- The Effects of CytoSorb in Critically Ill Adult Patients on Vasopressor Support: A Systematic Review and Meta-Analysis.Life (Basel, Switzerland) · 2026Review
48 more citing papers are in PubMed but not listed here.
Corrections and comments
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- Erratum issued
Authors and funding
23 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWe sought to clarify the benefit of cytokine adsorption in patients with COVID-19 supported with venovenous extracorporeal membrane oxygenation (ECMO).
methodsWe 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.
findingsFrom 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).
interpretationEarly 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.
fundingNone.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.