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[PMN elastase in extracorporeal circulation procedures].

K Rommelsheim, H Schlebusch, L Orellano

    Anasthesie, Intensivtherapie, Notfallmedizin
    |February 1, 1987
    PubMed
    Summary
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    Extracorporeal circulation significantly increases elastase levels, potentially causing lung injury similar to ARDS. This highlights risks associated with artificial gas exchange methods.

    Area of Science:

    • Biochemistry
    • Physiology
    • Medical Technology

    Background:

    • Proteolytic enzymes from neutrophils mediate organ failure in shock and sepsis.
    • Elastase, a key enzyme, is implicated in Acute Respiratory Distress Syndrome (ARDS).
    • Plasma elastase levels can indicate its release and potential systemic effects.

    Purpose of the Study:

    • To investigate the impact of extracorporeal circulation methods on elastase release.
    • To assess whether extracorporeal gas exchange induces ARDS-like disturbances.
    • To identify factors influencing elastase concentration during perfusion.

    Main Methods:

    • Measured plasma elastase-proteinase inhibitor complex concentrations in patients undergoing membrane and bubble oxygenation.
    • Compared in-vitro and in-vivo extracorporeal circulation models.

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  • Analyzed the influence of foreign material surface, perfusion time, and volume.

    • Main Results:

    • Elastase concentration increased more than sixfold during membrane and bubble oxygenation.
    • Perfusion parameters like surface material, time, and volume affected elastase levels.
    • In-vitro recirculation showed insignificant elastase rise, unlike in-vivo circulation.

    Conclusions:

    • Extracorporeal circulation can induce harmful, ARDS-type disturbances.
    • The lung's capillary bed and leukocyte activation are critical in this process.
    • Clinical use of extracorporeal gas exchange requires consideration of these potential adverse effects.