Extracorporeal Blood Purification Techniques in Sepsis and ARDS: Evaluation of ECCO₂R and CytoSorb® Hemoadsorption – A Narrative Review

Vollständiger Abstract

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Background: Sepsis is a life-threatening syndrome characterized by organ dysfunction resulting from a dysregulated host response to infection. It is associated with an imbalance between pro-inflammatory and anti-inflammatory pathways, leading to multiple organ injury, including acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS). Despite advances in critical care medicine, sepsis remains one of the leading causes of mortality in intensive care units (ICUs). Increasing interest has focused on extracorporeal blood purification techniques aimed at modulating cytokine levels and facilitating carbon dioxide removal. Aim: The aim of this study was to provide an overview and critical evaluation of two extracorporeal blood purification modalities—extracorporeal carbon dioxide removal (ECCO₂R) and CytoSorb therapy. Materials and Methods: A narrative literature review was conducted using the PubMed database. Publications available up to April 2026 were identified using keywords related to CytoSorb, hemoadsorption, ECCO₂R, sepsis, ARDS, and critical care. Priority was given to systematic reviews, meta-analyses, randomized controlled trials, and observational studies. The retrieved evidence was synthesized narratively. Results: Both ECCO₂R, which facilitates carbon dioxide clearance, and CytoSorb hemoadsorption therapy, which removes circulating cytokines and inflammatory mediators, demonstrate high efficacy. However, current clinical trials have not shown significant improvements in mortality. This discrepancy may be related to patient heterogeneity and the lack of phenotype-based selection. ECCO₂R may be beneficial in ARDS phenotypes characterized by predominant hypercapnia, whereas CytoSorb therapy may be most effective in patients with the hyperinflammatory delta sepsis phenotype.