Maladies Infectieuses Et Réanimation Médicale, CHU Rennes, 35033, Rennes, France.
INSERM, EFS Bretagne, UMR U1236, Université de Rennes 1, 35000, Rennes, France.
Crit Care. 2021 Jan 6;25(1):9. doi: 10.1186/s13054-020-03444-x.
Venoarterial 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.
We 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).
Baseline 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-α along with IL-10, a highly immunosuppressive cytokine.
VA-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.
体外膜肺氧合（VA-ECMO）为心源性休克的危重病患者提供心脏机械支持。尽管在 VA-ECMO 患者的管理方面取得了重要进展，但获得性感染仍然非常频繁，并且增加了死亡率。由于在危重病患者和体外循环手术后都描述了免疫功能障碍，因此 VA-ECMO 的启动可能会导致免疫改变，从而使患者容易发生医院获得性感染（NI）。因此，在这项前瞻性研究中，我们旨在研究 VA-ECMO 启动后最初几天内引起的免疫改变。
我们使用细胞术分析来研究 VA-ECMO 启动引起的免疫改变，以描述免疫细胞的变化，并使用酶联免疫吸附测定（ELISA）来探索血浆细胞因子水平。为了分析 VA-ECMO 启动引起的特定变化，我们将 9 名接受 VA-ECMO 的患者（VA-ECMO 患者）与 9 名心源性休克患者（对照组患者）进行了比较。
两组的基线免疫参数相似。VA-ECMO 与循环中不成熟中性粒细胞的显著增加相关，同时 C5a 受体表达显著降低。此外，我们发现 VA-ECMO 启动后会导致淋巴细胞功能障碍和髓样来源的抑制细胞（MDSC）扩张。ELISA 分析显示，VA-ECMO 启动后会导致促炎细胞因子（如 IL-6、IL-8 和 TNF-α）增加，同时还会导致高度免疫抑制性细胞因子 IL-10 增加。
VA-ECMO 与早期免疫改变相关，这可能是固有和适应性免疫改变的原因，从而增加了感染的风险。
