Feature of Cytosorb	Potential benefit	Comment
Large surface area and adsorption capacity	Allows reduction of cytokines in a rapid and clinically relevant timescale and exceed endogenous production	Far exceeds that offered by fibre based circuits. If this mechanism is relevant Cytosorb is probably one of the most efficient mechanisms
Non-selective removal of presented mediators	Possible feedback mechanism where the highest concentration mediator is most readily removed and ultimately all mediators are removed. Removal of pro and anti-inflammatory mediators may be beneficial7	This may have unexpected pro or anti-inflammatory effects. It is unclear as to what constitutes a “therapeutic response” and when Cytosorb requires changed or is exhausted
Relatively selective for cytokines	Limited removal of agents >50 kDa	Clearance of antibiotics and other drugs may be harmful and not well quantified. Many drugs are very effectively removed by Cytosorb (e.g. digoxin)
Technically simple	Can be entered into most circuits and being a haemoperfusion column needs little adjustment or pressure transduction, dialysate or replacement fluids. Avoids complexities of replacement blood products or sequential filtration	Requires an existing extracorporeal circuit. Clinicians may lack equipoise for this therapy in the absence of renal failure requiring CRRT