The inflammatory and coagulative response to prolonged extracorporeal membrane oxygenation

Extracorporeal circulation is used therapeutically during renal dialysis, cardiopulmonary bypass (CPB), and extracorporeal membrane oxygenation (ECMO). All of these procedures result in activation of the body's natural defense mechanisms against "nonself" and foreign invasion. The prolonged duration of ECMO compared with other applications and the absence of hypothermia, hemodilution, ischemia/reperfusion, and protamine administration make the host response to ECMO subtly distinct. In this review, the host response to ECMO is discussed and contrasted to CPB. The use of aprotinin and other response modifiers is also considered.