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Extracorporeal Circulation-Related Immune Response

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Management of Dysregulated Immune Response in the Critically Ill

Part of the book series: Lessons from the ICU ((LEICU))

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Abstract

Forms of extracorporeal circulation are increasingly used to support critically ill patients. Extracorporeal membrane oxygenation (ECMO) and renal replacement therapy (RRT) are two of the most widely used and are employed as bridges to recovery or as definitive therapy. While both are life-saving, they also have limitations. Of note, ECMO and RRT have been associated with dysregulation of the immune system. Both are known to trigger a pro-inflammatory response; alter leukocyte numbers, phenotype, and function; increase platelet/endothelial-leukocyte interplay; and lead to a pro-coagulant state, alongside some features of immunosuppression. These changes may be exacerbated by blood contacting non-endothelialised surfaces as well as the non-physiological conditions associated with these modalities. However, teasing out the immune effects caused by these modalities from the actual underlying disease burden is complex. This chapter describes and highlights the immune responses related to extracorporeal circulations. Additionally, it outlines the factors contributing to ECMO- and RRT-related immune dysregulation, and the role these changes play in device complications. An increased understanding and acknowledgement of the patient-pump and -oxygenator interphase may assist in guiding the design of targeted preventative actions in the future.

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Authors and Affiliations

  1. Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia

    Katrina K. Ki, Silver Heinsar & John F. Fraser

  2. Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia

    Katrina K. Ki, Silver Heinsar & John F. Fraser

  3. Clinical Immunology and Allergy, and Sullivan Nicolaides Pathology, Wesley Hospital, Brisbane, QLD, Australia

    Daman Langguth

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  1. Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary

    Zsolt Molnar

  2. Department of Critical Care, King’s College London, Guy’s & St Thomas’ NHS Foundation Trust, London, UK

    Marlies Ostermann

  3. The Queen’s Medical Research Institute Edinburgh BioQuarter, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK

    Manu Shankar-Hari

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Ki, K.K., Heinsar, S., Langguth, D., Fraser, J.F. (2023). Extracorporeal Circulation-Related Immune Response. In: Molnar, Z., Ostermann, M., Shankar-Hari, M. (eds) Management of Dysregulated Immune Response in the Critically Ill. Lessons from the ICU. Springer, Cham. https://doi.org/10.1007/978-3-031-17572-5_5

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