Abstract
A plethora of leukocyte modulations have been reported in critically ill patients. Critical illnesses such as acute respiratory distress syndrome and cardiogenic shock, which potentially require extracorporeal membrane oxygenation (ECMO) support, are associated with changes in leukocyte numbers, phenotype, and functions. The changes observed in these illnesses could be compounded by exposure of blood to the non-endothelialized surfaces and non-physiological conditions of ECMO. This can result in further leukocyte activation, increased platelet-leukocyte interplay, pro-inflammatory and pro-coagulant state, alongside features of immunosuppression. However, the effects of ECMO on leukocytes, in particular their phenotypic and functional signatures, remain largely overlooked, including whether these changes have attributable mortality and morbidity. The aim of our narrative review is to highlight the importance of studying leukocyte signatures to better understand the development of complications associated with ECMO. Increased knowledge and appreciation of their probable role in ECMO-related adverse events may assist in guiding the design and establishment of targeted preventative actions.
Highlights
Extracorporeal membrane oxygenation (ECMO) is a potentially lifesaving modality that supports critically ill patients with refractory cardiac and/or respiratory failure [1,2,3,4,5]
ECMO is associated with an increased risk of complications such as exacerbated systemic inflammatory response syndrome (SIRS), infection, new organ dysfunction, and thrombosis [6, 8,9,10]
Leukocytes are central to the pathophysiology of critical illness
Summary
Extracorporeal membrane oxygenation (ECMO) is a potentially lifesaving modality that supports critically ill patients with refractory cardiac and/or respiratory failure [1,2,3,4,5]. The use and number of ECMO centers have dramatically increased [6]. Beyond providing support to the heart and lungs, ECMO is used as a cardiopulmonary resuscitation tool and a bridge to transplant. The modern era of ECMO, post 2007, introduced significant advances in circuit design and improved expertise in clinical management [7]. Despite these improvements, adverse events remain common. ECMO is associated with an increased risk of complications such as exacerbated systemic inflammatory response syndrome (SIRS), infection, new organ dysfunction, and thrombosis [6, 8,9,10]
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