Cardiopulmonary bypass and VA-ECMO induced immune dysfunction: common features and differences, a narrative review – ScienceOpen
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      Cardiopulmonary bypass and VA-ECMO induced immune dysfunction: common features and differences, a narrative review

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          Abstract

          Cardiopulmonary bypass (CPB) and veno-arterial extracorporeal membrane oxygenation are critical tools in contemporary cardiac surgery and intensive care, respectively. While these techniques share similar components, their application contexts differ, leading to distinct immune dysfunctions which could explain the higher incidence of nosocomial infections among ECMO patients compared to those undergoing CPB. This review explores the immune modifications induced by these techniques, comparing their similarities and differences, and discussing potential treatments to restore immune function and prevent infections. The immune response to CPB and ECMO involves both humoral and cellular components. The kinin system, complement system, and coagulation cascade are rapidly activated upon blood contact with the circuit surfaces, leading to the release of pro-inflammatory mediators. Ischemia–reperfusion injury and the release of damage-associated molecular patterns further exacerbate the inflammatory response. Cellular responses involve platelets, neutrophils, monocytes, dendritic cells, B and T lymphocytes, and myeloid-derived suppressor cells, all of which undergo phenotypic and functional alterations, contributing to immunoparesis. Strategies to mitigate immune dysfunctions include reducing the inflammatory response during CPB/ECMO and enhancing immune functions. Approaches such as off-pump surgery, corticosteroids, complement inhibitors, leukocyte-depleting filters, and mechanical ventilation during CPB have shown varying degrees of success in clinical trials. Immunonutrition, particularly arginine supplementation, has also been explored with mixed results. These strategies aim to balance the inflammatory response and support immune function, potentially reducing infection rates and improving outcomes. In conclusion, both CPB and ECMO trigger significant immune alterations that increase susceptibility to nosocomial infections. Addressing these immune dysfunctions through targeted interventions is essential to improving patient outcomes in cardiac surgery and critical care settings. Future research should focus on refining these strategies and developing new approaches to better manage the immune response in patients undergoing CPB and ECMO.

          Graphical abstract

          Although often considered similar, CPB and ECMO have distinct immune repercussions. Numerous immunomodulatory strategies have been tested in cardiac surgery patients undergoing CPB to mitigate the induced immunoparesis, but no clinical trials have been conducted for patients on ECMO. C5aR (complement component 5a receptor), CPB (cardiopulmonary bypass), DC (dendritic cells), ECMO (extracorporeal membrane oxygenation), HLA-DR (human leukocyte antigen-DR isotype), NETs (neutrophil extracellular traps), PD-1 (program cell death protein 1), ROS (reactive oxygen species), TLR (toll-like receptor). Created with BioRender.com

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                Author and article information

                Contributors
                mathieu.lesouhaitier@gmail.com
                jeanmarc.tadie@chu-rennes.fr
                Journal
                Crit Care
                Critical Care
                BioMed Central (London )
                1364-8535
                1466-609X
                10 September 2024
                10 September 2024
                2024
                : 28
                : 300
                Affiliations
                [1 ]GRID grid.414271.5, Infectious Diseases and Intensive Care Unit, , Pontchaillou University Hospital, ; 2 rue Henri Le Guilloux, 35033 Rennes, France
                [2 ]SITI, Pole de Biologie, Pontchaillou University Hospital, Etablissement Français du Sang Bretagne, ( https://ror.org/037hby126) 2 rue Henri Le Guilloux, 35033 Rennes, France
                [3 ]GRID grid.410368.8, ISNI 0000 0001 2191 9284, UMR 1236, , Univ Rennes, INSERM, Etablissement Français du Sang Bretagne, ; Rennes, France
                [4 ]CIC-1414, INSERM, ( https://ror.org/02vjkv261) Rennes, France
                Article
                5058
                10.1186/s13054-024-05058-z
                11389086
                39256830
                f3e2bf07-ce73-427b-8f69-5e875762ecf2
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

                History
                : 25 June 2024
                : 6 August 2024
                Categories
                Review
                Custom metadata
                © BioMed Central Ltd., part of Springer Nature 2024

                Emergency medicine & Trauma
                cardiopulmonary bypass,extracorporeal membrane oxygenation,acquired immune dysfunctions

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