Beyond the infusion: nursing at the vanguard of cytokine release syndrome rescue in CAR-T cell therapy.

Chimeric antigen receptor (CAR) T cell therapy has revolutionized oncology but is fraught with a potentially lethal toxicity: cytokine release syndrome (CRS). While much focus is placed on pharmaceutical interventions, the pivotal role of nursing in the frontline detection, management, and rescue of patients from CRS remains under-championed in the literature. This narrative review synthesizes the current evidence to formally position nursing at the vanguard of CRS rescue. We delineate the intricate immunobiology of CRS as a primer for advanced practice and deconstruct its clinical spectrum to empower precise assessment. A novel four-pillar framework is presented, outlining nursing's critical role in pre-infusion preparedness, vigilant predictive monitoring, graded algorithm-driven intervention, and multidisciplinary coordination. Furthermore, we pioneer the discussion on defining nursing-sensitive outcomes (NSOs) specific to CRS to quantify nursing's impact on patient safety and efficacy. Finally, we explore future directions, including point-of-care testing and specialized nursing roles, advocating for a paradigm shift where nurses are recognized as essential leaders in optimizing safety and unlocking the full potential of CAR-T cell therapy.