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Pediatric ECMO: unfavorable outcomes are associated with inflammation and endothelial activation

Sherrill D Caprarola1, Derek K Ng2, Megan K Carroll2

  • 1Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Children's National Health System, Washington, DC, USA.

Pediatric Research
|November 4, 2021
PubMed

Insights

High levels of inflammatory and endothelial activation markers in children on extracorporeal membrane oxygenation (ECMO) correlate with mortality and abnormal neuroimaging. These findings highlight potential biomarkers for risk stratification in pediatric ECMO patients.

Area of Science:

  • Pediatric Critical Care Medicine
  • Cardiovascular Research
  • Biomarker Discovery

Background:

  • Extracorporeal membrane oxygenation (ECMO) support in children can trigger inflammatory and endothelial activation responses.
  • Understanding these responses is crucial for improving patient outcomes.

Purpose of the Study:

  • To investigate the association between circulating inflammatory, endothelial activation, and fibrinolytic markers and mortality in pediatric ECMO patients.
  • To determine if these markers correlate with neurologic outcomes in children undergoing ECMO.

Main Methods:

  • Secondary analysis of a prospective observational study involving 99 pediatric ECMO patients.
  • Measurement of inflammatory (IFNγ, IL-6, IL-1β, TNFα), endothelial activation (E-selectin, P-selectin, ICAM-3, TM), and fibrinolytic (tPA, PAI-1) markers in plasma during ECMO support.

Main Results:

  • Elevated inflammatory biomarkers on ECMO day 1 were associated with abnormal neuroimaging.
  • Higher ECMO day 1 and peak levels of IL-6 and PAI-1 were observed in non-survivors.
  • No significant association was found between tested biomarkers and long-term neurobehavioral outcomes.

Conclusions:

  • Circulating inflammatory, endothelial activation, and fibrinolytic markers are linked to mortality and abnormal neuroimaging in pediatric ECMO patients.
  • A proinflammatory and prothrombotic profile is significantly associated with mortality in multivariable models.
  • Further research is needed to identify specific profiles associated with neurologic injury and mortality risk.
Abstract

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