Influence of hemofiltration on plasma cytokine levels and platelet activation during extra corporeal membrane oxygenation.
OBJECTIVE
Extra corporeal circulation of human blood is used daily in lifesaving procedures such as open-heart surgery and extracorporeal membrane oxygenation (ECMO). But extracorporeal circulation also induces activation of various cascade reactions in the blood. The objective of this study was to evaluate the effects of hemofiltration on cytokine release and removal as well as on platelet activation and consumption.


METHODS
Two complete ECMO systems, each of them holding a hollow fiber oxygenator, a bladder box, PVC tubing and a roller pump were perfused for 24 h with fresh, heparinized human blood. A hemofilter was added to one of the paired systems. Blood samples were collected from both circuits before start, and at 0.5, 1, 3, 12 and 24 h of perfusion. A total of 8 paired experiments was performed.


RESULTS
The plasma concentration of interleukin (IL)1beta, IL-6 and IL-8, as well as of IL-1 receptor antagonist (IL-1ra) increased over time in both systems, but consistently lower levels were observed in the filter circuits compared to the controls. Only minor parts of these cytokines could be assayed in the ultrafiltrate. No significant difference in platelet count and platelet membrane expression of glycoprotein Ib was observed between the circuits.


CONCLUSIONS
By adding a hemofilter to the ECMO circuit, it is possible to reduce the plasma concentration of interleukins without significantly affecting platelet activation and consumption.
Institute for the Health of Women and Children, Department of Pediatrics, The Queen Silvia Children's Hospital, Göteborg, Sweden. vobmel@pediat.gu.se
M
M
Skogby
K
K
Adrian
L G
LG
Friberg
G
G
Mellgren
K
K
Mellgren
D016207:Cytokines / Q000097:blood*; D015199:Extracorporeal Membrane Oxygenation; D006440:Hemofiltration; D006452:Hemoglobinometry; D006801:Humans; D066298:In Vitro Techniques; D007958:Leukocyte Count; D009504:Neutrophils / Q000276:immunology; D015539:Platelet Activation / Q000502:physiology*; D010976:Platelet Count; D010980:Platelet Membrane Glycoproteins / Q000378:metabolism; D001620:beta-Thromboglobulin / Q000378:metabolism
D016207:Cytokines; D010980:Platelet Membrane Glycoproteins; D001620:beta-Thromboglobulin