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.