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Cardiopulmonary bypass and VA-ECMO induced immune dysfunction: common features and differences, a narrative review
Mathieu Lesouhaitier1,2,3,4, Félicie Belicard5,6,7, Jean-Marc Tadié8,9,10,11
1Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France. mathieu.lesouhaitier@gmail.com.
Critical Care (London, England)
|September 10, 2024
Summary
Cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) significantly alter immune function, increasing infection risk. Targeted interventions are crucial for improving patient outcomes in critical care and cardiac surgery.
Area of Science:
- Immunology
- Critical Care Medicine
- Cardiovascular Surgery
Background:
- Cardiopulmonary bypass (CPB) and veno-arterial extracorporeal membrane oxygenation (ECMO) are vital life support technologies.
- Despite shared components, CPB and ECMO applications lead to distinct immune dysfunctions and infection rates.
Purpose of the Study:
- To review and compare immune modifications induced by CPB and ECMO.
- To discuss strategies for mitigating immune dysfunction and preventing infections associated with these techniques.
Main Methods:
- Literature review of immune responses to CPB and ECMO.
- Analysis of humoral and cellular immune alterations.
- Evaluation of current and potential therapeutic interventions.
Main Results:
- Both CPB and ECMO activate inflammatory pathways (kinin, complement, coagulation) and cellular immune cells.
- These interventions induce immunoparesis, increasing susceptibility to nosocomial infections.
- Various strategies, including anti-inflammatory agents and immunonutrition, show mixed success.
Conclusions:
- CPB and ECMO significantly impair immune function, raising infection risk.
- Targeted interventions are necessary to manage immune dysfunctions and improve patient outcomes.
- Further research is needed to refine existing strategies and develop novel approaches.
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