Since 1994, a polystyrene fiber cartridge used for extracorporeal hemoperfusion, to which polymyxin B is bound and immobilized (Toraymyxin – Toray Medical Ltd, Japan), has been used for septic shock patients in order to absorb and remove circulating lipopolysaccharide, neutralizing its effects. This therapy gradually gained acceptance as the amount of evidence increased from initial small clinical studies to a carefully conducted systematic review, and ultimately to the multicentered randomized clinical trial conducted in Italy, entitled the EUPHAS Study (Early Use of Polymyxin B Hemoperfusion in Abdominal Septic Shock) published on the Journal of American Medical Association in 2009.
While the conclusions of this randomized controlled trial were in agreement with previous studies, it possessed some important limitations, above all a modest patient sample size, which may have overestimated the true magnitude of the clinical effect.
Apart from Japan, Italy is the current primary user of polymyxin B-hemoperfusion in the treatment of endotoxin septic shock, with about 600 cartridges being used per year. However, no structured collection of data has been attempted, resulting in the opportunity to understand the effects of polymyxin B-hemoperfusion on a large, diverse sample size. In response, Italian investigators and users of this treatment have designed a new prospective multicentered, collaborative data collection project, entitled EUPHAS 2. The aim of this project is to collect a large database regarding polymyxin B hemoperfusion treatment in order to better evaluate the efficacy and biological significance of endotoxin removal in clinical practice.
Additionally, this project aims to verify the reproducibility of the data currently available in the literature, evaluate the patient population chosen for treatment and identify subpopulations of patients who may benefit from this treatment more than others.