The COSMOS registry, sponsored by CytoSorbents, Inc., aims to establish a comprehensive data repository for the use of the CytoSorb device in critical care settings. This initiative is expected to enhance the understanding of the device's efficacy in real-world applications, particularly in conditions such as septic shock and acute respiratory distress syndrome. The registry's findings could strengthen CytoSorbents' market position by providing robust clinical evidence to support the device's use, potentially leading to increased adoption in critical care units. The competitive landscape includes other hemoperfusion devices, but the unique focus on cytokine removal may provide a differentiated value proposition. Diligence considerations should include the regulatory landscape and potential reimbursement pathways for the device.