Jd. Fortenberry et al., NEUTROPHIL AND CYTOKINE ACTIVATION WITH NEONATAL EXTRACORPOREAL MEMBRANE-OXYGENATION, The Journal of pediatrics, 128(5), 1996, pp. 670-678
Objective: To determine whether extracorporeal membrane oxygenation (E
CMO), like cardiopulmonary bypass, produces systemic inflammatory resp
onses that could potentiate organ injury in infants with respiratory f
ailure. Study design: We evaluated the effects of neonatal ECMO on neu
trophil surface adherence proteins, elastase release, and cytokine lev
els in blood samples from 15 patients before and during ECMO, and from
banked blood and ECMO circuit blood before cannulation. Neutrophil el
astase, tumor necrosis factor alpha, and interleukin types 1 beta, 6,
and 8 were measured. Chest radiographs were evaluated by a radiologist
using a lung injury score in blinded fashion. Results: Primed ECMO ci
rcuit blood, in comparison with patient pre-ECMO blood, demonstrated m
arked up-regulation of CD11b (mean fluorescence intensity 1660 +/- 109
vs 361 +/- 81; p < 0.001 (mean +/- SEM)), shedding of L-selectin (mea
n fluorescence intensity 10 +/- 2 vs 89 +/- 38; p < 0.01), and elevate
d elastase levels (349 +/- 76 vs 154 ng/ml +/- 38; p < 0.001), consist
ent with neutrophil activation, During ECMO, neutrophil CD11b levels i
ncreased but L-selectin was not significantly shed. Concentrations of
circulating neutrophil elastase increased significantly during ECMO, C
orrected circulating quantities of interleukin-8 also rose significant
ly, but the responses of tumor necrosis factor alpha and interleukin-1
beta were minimal, Radiographic lung injury scores worsened with the
initiation of ECMO (median score: 6 before ECMO vs 11 in first hour of
ECMO; p = 0.012), in conjunction with indicators of neutrophil activa
tion. Conclusion: Neonates with respiratory failure have activation of
the inflammatory cascade, ECMO incites additional neutrophil and cyto
kine activation in association with early pulmonary deterioration, Rou
tine leukodepletion of blood for circuit priming to remove activated n
eutrophils may be beneficial.