Sepsis is one of the leading causes of morbidity and mortality worldwide. It is characterized by a dysregulated immune response to infections that results in life-threatening organ dysfunction and even death. Bacterial cell wall components (endotoxin or lipopolysaccharide), known as pathogen-associated molecular patterns (PAMPs), as well as damage-associated molecular patterns (DAMPs) released by host injured cells, are well-recognized triggers resulting in the elevation of both pro-inflammatory and anti-inflammatory cytokines. Understanding this complex pathophysiology has led to the development of therapeutic strategies aimed at restoring a balanced immune response by eliminating/deactivating these inflammatory mediators. Different extracorporeal techniques have been studied in recent years in the hope of maximizing the effect of renal replacement therapy in modulating the exaggerated host inflammatory response, including the use of high volume hemofiltration (HVHF), high cut-off (HCO) membranes, adsorption alone, and coupled plasma filtration adsorption (CPFA). These strategies are not widely utilized in practice, depending on resources and local expertise. The literature examining their use in septic patients is growing, but the evidence to support their use at this stage is considered of low level. Our aim is to provide a comprehensive overview of the technical aspects, clinical applications, and associated side effects of these techniques.

Background: The prognostic value of quick sepsis-related organ failure assessment (qSOFA) outside intensive care units has been criticized. Therefore, we aimed to improve its ability in predicting 30-day all-cause mortality, and in ruling out the cases at high risk of death among patients with suspected or confirmed sepsis at emergency department (ED) admission. Methods: This study is a secondary analysis of a prospective multicenter study. We built three predictive models combining qSOFA with the clinical variables and serum biomarkers that resulted in an independent association with 30-day mortality, in both 848 undifferentiated patients (Group 1) and in 545 patients definitively diagnosed with sepsis (Group 2). The models reaching the highest negative predictive value (NPV) with the minimum expenditure of biomarkers in Group 1 and in Group 2 were validated in two cohorts of patients initially held out due to missing data. Results: In terms of the area under the receiver-operating characteristic curve, all six models significantly exceeded qSOFA in predicting prognosis. An “extended” qSOFA (eqSOFA1) in Group 1 and an eqSOFA2 integrated with C-reactive protein and mid-regional proadrenomedullin (eqSOFA2+CRP+MR-proADM) in Group 2 reached the best NPV (0.94 and 0.93, respectively) and ease of use. eqSOFA1 and eqSOFA2+CRP+MR-proADM performed equally well in both the inception and validation cohorts. Conclusions: We have derived and validated two prognostic models that outweigh qSOFA in predicting mortality and in identifying the low risk of death among patients with suspected or confirmed sepsis at ED admission.

Out-of-hospital cardiac arrest (OHCA) is one of the most important causes of death worldwide. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an interesting new device that has been developed as a bridge therapy to treat trauma patients with non-compressible torso hemorrhage. REBOA has also been tested in non-traumatic OHCA, but the results are inconclusive. The aim of this review is to describe the state of the art in the use of REBOA for the management of non-traumatic out-of-hospital cardiac arrest. We performed a state-of-the-art review of the literature, searching for the therapeutic role of REBOA in the management of non-traumatic OHCA. We interviewed PubMed, Central, and Embase, and searched for citations before May 2023 using these criteria: “non-traumatic out-of-hospital cardiac arrest” and “resuscitative endovascular balloon occlusion of the aorta”. We selected only observational studies because controlled trials have not been published yet. All studies demonstrated the feasibility of REBOA placement in the management of non-traumatic OHCA and the improvement of all perfusion markers. Although some important uncertainties still remain, REBOA has the potential to become a new cornerstone in the therapy of OHCA and change the management of cardiac arrest, especially in remote locations which require a long time for scene arrival and an even longer time for metropolitan hospital arrival, where an ECPR is available.