Abstract
The accumulation of blood proteins and cells on extracorporeal membrane oxygenation (ECMO) circuits has been proposed as a contributing factor to the coagulopathic state of many patients. This systematic review aims to summarize and discuss the existing knowledge of blood components binding to the ECMO circuits in human patients. A systematic review was conducted using the Medline, PubMed and Embase databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seven studies were included in this review. Three studies identified a leukocyte adhesion, three studies observed von Willebrand factor accumulation and four studies identified bound platelets on the surface of the circuits. Other identified components included fibrin, albumin, hemoglobin, erythrocytes, progenitor cells, fibronectin and IgG. This systematic review demonstrates the limited state of knowledge when it comes to adsorption to the ECMO circuits in humans. Most of the studies lacked insight or detail into the mechanisms of binding and the interactions between different components bound to the ECMO circuits. Further research is required to comprehensively characterize surface adsorption to ECMO circuits in humans and to define the specific mechanisms of binding, enabling improvements that increase biocompatibility between the blood-circuit interface in this important clinical setting.
Highlights
Extracorporeal membrane oxygenation (ECMO) is a modified form of cardiopulmonary bypass (CPB), which provides cardiac and/or respiratory support for critically ill patients
Whilst previous studies detailing surface binding in non-ECMO settings [6] and animal models do exist [7,8], limited ECMO circuit binding studies have been conducted in an ex vivo ECMO setting in humans
The binding of blood cells and proteins to ECMO surfaces is likely associated with ECMO complications responsible for high morbidity including thrombosis and bleeding
Summary
Extracorporeal membrane oxygenation (ECMO) is a modified form of cardiopulmonary bypass (CPB), which provides cardiac and/or respiratory support for critically ill patients. One of the primary causes hypothesized to initiate a coagulopathic state in ECMO patients is the increased contact of blood components with the artificial ECMO circuit. One consequence of ECMO support that has not been investigated in detail is the adsorption of blood components to the surface of the ECMO circuit. This systematic review aims to summarize the current understanding of cellular and protein adsorption in the setting of ECMO in humans by identifying and examining the studies that have experimentally confirmed adherence of blood components to ECMO circuit surfaces. Provide a structured summary including as applicable background, objectives, data sources, study eligibility criteria, participants and interventions, study appraisal and synthesis methods, results, limitations, conclusions and implications of key findings, systematic review registration number.
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