Inflammatory Cytokine and Chemokine Concentrations Pre- and Post-Ecmo: A Prospective Clinical Study

The expanded use of extracorporeal membrane oxygenation (ECMO) is driven by its documented benefits, including mitigation of hypercarbia, acidosis, and concomitant pulmonary vascular resistance. However, the potential contribution of ECMO to the systemic inflammatory response continues to halt clinical decisions to utilize the strategy. The objective of our study is to evaluate the role of inflammatory cytokines and chemokines in ECMO patients pre-ECMO and up to 48 hours post-ECMO.

Blood samples from consenting adults who received ECMO treatment (either venovenous or venoarterial) were collected pre-ECMO and on day 1 or 2 post-ECMO cannulation immediately. Samples were analyzed by BioPlex assay, where antibodies and red and infrared fluorophores were attached to each surface of a bead, which was combined with the plasma sample. Biotinylated detection antibodies were added to quantify the analytes, and lasers read the color code of each bead and measured the fluorescence of the biotin-bound streptavidin conjugates.

Thirty-eight of the 46 analytes measured decreased post-ECMO initiation. The following analytes were significantly decreased between pre- and post-ECMO initiation: interleukin (IL)-16 ( P = 0.027), RANTES ( P = 0.022), IL-8 ( P = 0.022), interferon-gamma ( P = 0.025), and IL-9 ( P = 0.022).

We have shown that baseline values of most of the inflammatory cytokines and chemokines are not exacerbated by placement on ECMO. Instead, we provide preliminary evidence that placement on ECMO may attenuate the inflammatory and immune response to cardiopulmonary injury. Further studies will increase the number of subject data analyzed and their timepoints.