Inflammatory response
Contact of the patient’s blood with the extracorporeal circuit equipment activates coagulation cascade, complement systems and cytokines, recruiting leukocytes and platelets which then damage endothelial cells on vessels and lead to a hypercoagulable state. Neutrophils are thought to be activated in the oxygenator of the ECMO30. Neutrophilic infiltration into tissues can then cause organ damage31. The inflammatory response is similar to that in systemic inflammatory response syndrome (SIRS), causing an increased risk of thrombosis, infections, sepsis and end-organ damage thus worsening patient outcomes.
Prophylactic steroid treatment has shown to reduce postoperative infections, length of stay and reduce infections, however it did not change mortality rates . Mesenchymal stromal cells in animal models have shown to downregulate inflammatory factors and upregulate anti-inflammatory factors and can be promising solutions to be used in patients. Hemadsorption cytokine removal therapy has also shown to reduce CRP and IL-6. However these solutions are novel and more research should be undertaken to ascertain their benefits.