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The Functional Immune Response of Patients on Extracorporeal Life Support

Beshish, Asaad G.*; Bradley, Jeffrey D.; McDonough, Kelli L.*; Halligan, Nadine L. N.*; McHugh, Walker M.*; Sturza, Julie*; Hall, Mark W.; Cornell, Timothy T.*; Dahmer, Mary K.*

doi: 10.1097/MAT.0000000000000748
Clinical Critical Care
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SDC

Extracorporeal life support (ECLS) is a widely used lifesaving technology. Whether ECLS results in immune dysregulation is unclear. This study’s aim was to examine whether ECLS affected innate immune response. All patients placed on ECLS were eligible. Blood was obtained before, during, and after ECLS. Function of the innate immune system was measured by ex vivo lipopolysaccharide (LPS)-induced tumor necrosis factor-α (TNF-α) and plasma cytokine levels (interleukin [IL]-6, IL-8, IL-10, and TNF-α). Immunoparalysis was defined as ex vivo TNF-α levels less than 200 pg/ml. Nineteen patients were enrolled with twelve <18 years old. Median ECLS duration was 10 days (range: 3–108); nine patients died. After stratifying the cohort by the presence of immunoparalysis before ECLS, those immunoparalyzed showed increased response to LPS on days 1 and 3 (p = 0.016). Those without pre-ECLS immunoparalysis showed a transient decrease in response on day 3 (p = 0.008). Plasma IL-10 levels were elevated in those with pre-ECLS immunoparalysis and dropped significantly by day 1 (p = 0.031). The number treated with steroids was similar in the two groups. In conclusion, patients with immunoparalysis before ECLS showed a gradual increase in immune function during ECLS, whereas those without immunoparalysis had a transient decrease in responsiveness on day 3.

From the *Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, C.S. Mott Children’s Hospital, Ann Arbor, Michigan

ECMO Department, University of Michigan, Ann Arbor, Michigan

Division of Pediatric Critical Care Medicine, Department of Pediatrics, Ohio State University, Nationwide Children’s Hospital, Columbus, Ohio.

Submitted for consideration June 2017; accepted for publication in revised form December 2017.

Disclosure: Asaad G. Beshish received an internal grant from the Percy J. Murphy, M.D. and Mary C. Murphy, R.N. Endowed Children’s Research Fund to support this study. Mark W. Hall is a paid member of a Scientific Advisory Board for Bristol-Myers Squibb. This position poses no conflict with the work presented in the current manuscript. The other authors have no conflicts of interest to report.

This study was supported by an internal departmental grant, The Percy J. Murphy M.D. and Mary C. R.N. Murphy Endowed Children’s Research Fund Award.

Correspondence: Mary K. Dahmer, Pediatric Critical Care Medicine, University of Michigan Medical School, 1500 E. Medical Center Drive, F 6790/SPC 5243, Ann Arbor, MI 48109. Email: mkdahmer@umich.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs