Systematic review with expert consensus on use of extracorporeal hemoadsorption in septic shock: An Indian perspective

Table 1 Consensus statement and summary of overall agreement

Questions	Responses, n = 11 (%)		Consensus status - overall agreement
	Agreed/yes (%)	Disagreed/no (%)
Q1. Is there a need for adjuvant therapy in the management of refractory septic shock patients, when standard of care is insufficient?	10 (90.91)	1 (9.09)	A total of 90.91% experts agreed on the need for adjuvant therapy in the management of refractory septic shock patients, when the standard of care is insufficient. (Consensus Achieved)
Q2. In case of refractory septic shock cycle, CytoSorb® ideally be initiated within a maximum of 24 h after diagnosis and start of standard therapy	11 (100)	0 (0)	All experts (100%) agreed that in refractory septic shock cycle, CytoSorb® ideally be initiated within a maximum of 24 h after diagnosis and start of standard therapy. (Consensus Achieved)
Q3. IL-6 levels are not a mandatory parameter to decide on using CytoSorb® therapy in refractory septic shock patients	10 (90.91)	1 (9.09)	A total of 90.91% experts agreed that IL-6 levels are not a mandatory parameter to decide on using CytoSorb® therapy in refractory septic shock patients. (Consensus Achieved)
Q4. There are patients who may require more than one CytoSorb® adsorber to achieve sufficient haemodynamic stabilization	10 (90.91)	1 (9.09)	A total of 90.91% experts agreed that there are patients who may require more than one CytoSorb® adsorber to achieve sufficient haemodynamic stabilization. (Consensus Achieved)
Q5. If you want to continue with CytoSorb® therapy, the absorber should be changed after 6-24 h depending on the clinical course and the machine type availability	11 (100)	0 (0)	All experts (100%) agreed that if CytoSorb® therapy is continued, the absorber should be changed after 6-24 h depending on the clinical course and the machine type availability. (Consensus Achieved)
Q6. CytoSorb® therapy is generally a safe therapy	10 (90.91)	1 (9.09)	A total of 90.91% experts agreed that CytoSorb® is generally a safe therapy. (Consensus Achieved)
Q7. Sepsis-induced AKI requiring RRT is no prerequisite to initiate CytoSorb® therapy in refractory septic shock patients	11 (100)	0 (0)	All experts (100%) agreed that sepsis-induced AKI requiring RRT is not a prerequisite to initiate CytoSorb® therapy in refractory septic shock patients. (Consensus Achieved)
Q8. Evaluation of the efficacy of CytoSorb® therapy should be based on more proximal endpoints like haemodynamic stabilization, inflammatory biomarkers, and/or improvement in the organ function instead of mortality	10 (90.91)	1 (9.09)	A total of 90. 91% experts agreed that the evaluation of the efficacy of CytoSorb® therapy should be based on endpoints like haemodynamic stabilization, inflammatory biomarkers, and/or improvement in the organ function instead of mortality. (Consensus Achieved)
Q9. Do you think this flowchart can be helpful to a doctor very new to the therapy to ensure a certain level of best practice?	11 (100)	0 (0)	All experts (100%) agreed on the (revised) flowchart for doctor who are new to the therapy to ensure a certain level of best practice. (Consensus Achieved)

AKI: Acute kidney injury; RRT: Renal replacement therapy.

Table 2 Summary of consensus statements

Number	Summary of consensus statements
1	There is the need for adjuvant therapy (CytoSorb® haemoadsorption) in the management of refractory septic shock patients, when the standard of care is insufficient
2	In refractory septic shock cycle, CytoSorb® ideally be initiated within a maximum of 24 h after diagnosis and start of standard therapy
3	In the initiation of CytoSorb® therapy in refractory septic shock patient, IL-6 levels are not a pre-requisite or mandatory parameter for decision making
4	In a subset of patients, more than one CytoSorb® adsorber may be required to achieve sufficient haemodynamic stabilization
5	In continuation of CytoSorb® therapy, the absorber should be changed after 6-24 h depending on the clinical course and the machine type availability
6	CytoSorb® therapy is generally a safe therapy
7	Sepsis-induced AKI requiring RRT is not a prerequisite to initiate CytoSorb® therapy in refractory septic shock patients
8	The evaluation of the efficacy of CytoSorb® therapy should be based on endpoints like haemodynamic stabilization, inflammatory biomarkers, and/or improvement in the organ function, instead of mortality
9	The (displayed, Figure 2) flowchart can be helpful to a doctor very new to the therapy to ensure a certain level of best practice

AKI: Acute kidney injury; RRT: Renal replacement therapy.