Venoarterial extracorporeal membrane oxygenation induces early immune alterations

BackgroundVenoarterial extracorporeal membrane oxygenation (VA-ECMO) provides heart mechanical support in critically ill patients with cardiogenic shock. Despite important progresses in the management of patients under VA-ECMO, acquired infections remain extremely frequent and increase mortality rate. Since immune dysfunctions have been described in both critically ill patients and after surgery with cardiopulmonary bypass, VA-ECMO initiation may be responsible for immune alterations that may expose patients to nosocomial infections (NI). Therefore, in this prospective study, we aimed to study immune alterations induced within the first days by VA-ECMO initiation.MethodsWe studied immune alterations induced by VA-ECMO initiation using cytometry analysis to characterize immune cell changes and enzyme-linked immunosorbent assay (ELISA) to explore plasma cytokine levels. To analyze specific changes induced by VA-ECMO initiation, nine patients under VA-ECMO (VA-ECMO patients) were compared to nine patients with cardiogenic shock (control patients).ResultsBaseline immune parameters were similar between the two groups. VA-ECMO was associated with a significant increase in circulating immature neutrophils with a significant decrease in C5a receptor expression. Furthermore, we found that VA-ECMO initiation was followed by lymphocyte dysfunction along with myeloid-derived suppressor cells (MDSC) expansion. ELISA analysis revealed that VA-ECMO initiation was followed by an increase in pro-inflammatory cytokines such as IL-6, IL-8 and TNF-alpha along with IL-10, a highly immunosuppressive cytokine.ConclusionVA-ECMO is associated with early immune changes that may be responsible for innate and adaptive immune alterations that could confer an increased risk of infection.

Automated summary

This study revealed that the initiation of VA-ECMO leads to early immune alterations, including increased circulating immature neutrophils, decreased C5a receptor expression, lymphocyte dysfunction, and expansion of myeloid-derived suppressor cells (MDSC). ELISA analysis further showed an increase in pro-inflammatory cytokines such as IL-6, IL-8, and TNF-alpha, along with the highly immunosuppressive cytokine IL-10, following VA-ECMO initiation. These findings suggest that VA-ECMO may cause immune changes that increase the risk of infection.