The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology

Millar, Jonathan E., Fanning, Jonathon P., McDonald, Charles I., McAuley, Daniel F. and Fraser, John F. (2016) The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology. Critical Care, 20 1: 387. doi:10.1186/s13054-016-1570-4


Author Millar, Jonathan E.
Fanning, Jonathon P.
McDonald, Charles I.
McAuley, Daniel F.
Fraser, John F.
Title The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology
Journal name Critical Care   Check publisher's open access policy
ISSN 1466-609X
1364-8535
Publication date 2016-11-28
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1186/s13054-016-1570-4
Open Access Status DOI
Volume 20
Issue 1
Start page 387
Total pages 10
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Abstract Extracorporeal membrane oxygenation (ECMO) is a technology capable of providing short-term mechanical support to the heart, lungs or both. Over the last decade, the number of centres offering ECMO has grown rapidly. At the same time, the indications for its use have also been broadened. In part, this trend has been supported by advances in circuit design and in cannulation techniques. Despite the widespread adoption of extracorporeal life support techniques, the use of ECMO remains associated with significant morbidity and mortality. A complication witnessed during ECMO is the inflammatory response to extracorporeal circulation. This reaction shares similarities with the systemic inflammatory response syndrome (SIRS) and has been well-documented in relation to cardiopulmonary bypass. The exposure of a patient's blood to the non-endothelialised surface of the ECMO circuit results in the widespread activation of the innate immune system; if unchecked this may result in inflammation and organ injury. Here, we review the pathophysiology of the inflammatory response to ECMO, highlighting the complex interactions between arms of the innate immune response, the endothelium and coagulation. An understanding of the processes involved may guide the design of therapies and strategies aimed at ameliorating inflammation during ECMO. Likewise, an appreciation of the potentially deleterious inflammatory effects of ECMO may assist those weighing the risks and benefits of therapy.
Keyword Coagulation
ECMO
Extracorporeal membrane oxygenation
Inflammation
SIRS
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID HTA/13/143/02
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
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