Cardiothoracic & vascular anesthesia
Cardiopulmonary bypass and VA-ECMO induced immune dysfunction: common features and differences, a narrative review
Authors' conclusion
In conclusion, both CPB and ECMO trigger significant immune alterations that increase susceptibility to nosocomial infections.
Study context
- Population
- Patients undergoing cardiopulmonary bypass (CPB) in cardiac surgery or VA-ECMO in intensive care
- Comparison
- CPB vs VA-ECMO induced immune dysfunction
- Outcome
- Immune response to CPB and ECMO
Main finding
As reported in the abstract
- Higher incidence of nosocomial infections among ECMO patients vs CPB, possibly explained by distinct immune dysfunctions
- Humoral response: rapid activation of kinin, complement and coagulation systems on blood contact with circuit surfaces, releasing pro-inflammatory mediators; ischaemia-reperfusion injury and damage-associated molecular patterns exacerbate inflammation
- Cellular response: platelets, neutrophils, monocytes, dendritic cells, B and T lymphocytes and myeloid-derived suppressor cells undergo phenotypic and functional alterations, contributing to immunoparesis
- Off-pump surgery, corticosteroids, complement inhibitors, leukocyte-depleting filters and mechanical ventilation during CPB: varying degrees of success in clinical trials
- Immunonutrition, particularly arginine supplementation: mixed results
Original publication
Cardiopulmonary bypass and VA-ECMO induced immune dysfunction: common features and differences, a narrative review. Crit Care. Published 10 September 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →