Aurélien Frerou1, Mathieu Lesouhaitier1, Murielle Gregoire2,3, Fabrice Uhel1, Arnaud Gacouin1, Florian Reizine1, Caroline Moreau4, Aurélie Loirat5, Adel Maamar1, Nicolas Nesseler6, Amedeo Anselmi7, Erwan Flecher7, Jean-Philippe Verhoye7, Yves Le Tulzo1, Michel Cogné2,3, Mikael Roussel2,3, Karin Tarte2,3, Jean-Marc Tadié8,9,10. 1. Maladies Infectieuses Et Réanimation Médicale, CHU Rennes, 35033, Rennes, France. 2. INSERM, EFS Bretagne, UMR U1236, Université de Rennes 1, 35000, Rennes, France. 3. Pôle Biologie, CHU Rennes, 35033, Rennes, France. 4. Service de Bactériologie, CHU Rennes, 35033, Rennes, France. 5. Service de Cardiologie et maladies vasculaires, CHU de Rennes, 35033, Rennes, France. 6. Anesthésie-Réanimation, CHU Rennes, 35033, Rennes, France. 7. Chirurgie Cardio-Thoracique Et Vasculaire, CHU Rennes, 35033, Rennes, France. 8. Maladies Infectieuses Et Réanimation Médicale, CHU Rennes, 35033, Rennes, France. jeanmarc.tadie@chu-rennes.fr. 9. INSERM, EFS Bretagne, UMR U1236, Université de Rennes 1, 35000, Rennes, France. jeanmarc.tadie@chu-rennes.fr. 10. Pôle Biologie, CHU Rennes, 35033, Rennes, France. jeanmarc.tadie@chu-rennes.fr.
Abstract
BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSION: 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.
BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides heart mechanical support in critically illpatients 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 illpatients 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. METHODS: 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-ECMOpatients) were compared to nine patients with cardiogenic shock (control patients). RESULTS: 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. CONCLUSION: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.
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