The inflammatory and coagulative response to prolonged extracorporeal membrane oxygenation

Extracorporeal circulation is used therapeutically during renal dialysis, c ardiopulmonary bypass (CPB), and extracorporeal membrane oxygenation (ECMO) . All of these procedures result in activation of the body's natural defens e mechanisms against "nonself" and foreign invasion. The prolonged duration of ECMO compared with other applications and the absence of hypothermia, h emodilution, ischemia/reperfusion, and protamine administration make the ho st response to ECMO subtly distinct. In this review, the host response to E CMO is discussed and contrasted to CPB. The use of aprotinin and other resp onse modifiers is also considered.