Effects of simulated extracorporeal circulation on human leukocyte elastase release, superoxide generation, and procoagulant activity

Stahl, Russell F.; Fisher, Carol A.; Kucich, Umberto; Weinbaum, George; Warsaw, David S.; Stenach, Nina; O'Connor, C.; Addonizio, V. Paul

doi:10.1016/s0022-5223(19)36757-1

Cited by 53 publications

(11 citation statements)

References 30 publications

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“…Similar to us, Menaschê et al (16) and Prasad et al (17) reported that the potential activity of neutrophils evaluated by free radical release is increased in patients undergoing aortocoronary bypass surgery. Stahl et al also reported neutrophils demonstrating increased sensitivity to soluble agonist in simulated extracorporeal circulation (18). As in trauma victims, it appears that postoperative patients have neutrophil hyperactivity following surgery, making them susceptible to neutrophil‐mediated organ injury.…”

Section: Discussionmentioning

confidence: 96%

Enhanced Responsiveness of Circulatory Neutrophils After Cardiopulmonary Bypass: Increased Aggregability and Superoxide Producing Capacity

et al. 2000

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Cardiac surgery with cardiopulmonary bypass (CPB) induces a whole body inflammatory response that sometimes leads to postoperative organ dysfunction, and neutrophil activation plays an important role in this reaction. Neutrophil priming has been described as a change in neutrophil status such that neutrophils show enhanced responsiveness to a second activating stimulus. We hypothesized that neutrophil priming occurs by cardiac surgery with CPB and is temporally related to the neutrophilia after surgery. To evaluate primed circulatory neutrophil status, we measured aggregation activity stimulated by N-formyl-methyl-leucyl-phenyl-alanine (FMLP) and free radical producing activity by tumor necrosing factor (TNF) alpha in peripheral blood samples. Eleven adult patients undergoing elective cardiac surgery with CPB were studied. Blood samples were taken before surgery, at the end of bypass, 12 h after surgery, and 7 days after surgery. Aggregation activity and superoxide generation were significantly elevated 12 h after surgery when compared to presurgery values, indicating that cardiac surgery is associated with circulatory neutrophil priming. The number of neutrophils markedly increased at the end of cardiopulmonary bypass and reached a peak 12 h after surgery. The circulatory neutrophils of cardiac surgical patients become primed after surgery, coincident with the peak neutrophil count. These results suggest that circulatory neutrophils after cardiac surgery with CPB have enhanced responsiveness and are predisposed to systemic inflammation.

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Section: Discussionmentioning

confidence: 96%

Enhanced Responsiveness of Circulatory Neutrophils After Cardiopulmonary Bypass: Increased Aggregability and Superoxide Producing Capacity

et al. 2000

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“…ECMO treatment in itself will trigger or aggravate a systemic inflammatory response (SIRS), resulting in a so-called capillary leakage syndrome [ 1 ]. High levels of circulating endotoxins, exotoxins, interleukins and leukotrienes influence the basal membranes [ 2 ]. Moreover the ECMO system activates leucocytes, thrombocytes and the complement system [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Haemofiltration in newborns treated with extracorporeal membrane oxygenation: a case-comparison study

et al. 2009

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IntroductionExtracorporeal membrane oxygenation is a supportive cardiopulmonary bypass technique for patients with acute reversible cardiovascular or respiratory failure. Favourable effects of haemofiltration during cardiopulmonary bypass instigated the use of this technique in infants on extracorporeal membrane oxygenation. The current study aimed at comparing clinical outcomes of newborns on extracorporeal membrane oxygenation with and without continuous haemofiltration.MethodsDemographic data of newborns treated with haemofiltration during extracorporeal membrane oxygenation were compared with those of patients treated without haemofiltration in a retrospective 1:3 case-comparison study. Primary outcome parameters were time on extracorporeal membrane oxygenation, time until extubation after decannulation, mortality and potential cost reduction. Secondary outcome parameters were total and mean fluid balance, urine output in mL/kg/day, dose of vasopressors, blood products and fluid bolus infusions, serum creatinin, urea and albumin levels.ResultsFifteen patients with haemofiltration (HF group) were compared with 46 patients without haemofiltration (control group). Time on extracorporeal membrane oxygenation was significantly shorter in the HF group: 98 hours (interquartile range (IQR) = 48 to 187 hours) versus 126 hours (IQR = 24 to 403 hours) in the control group (P = 0.02). Time from decannulation until extubation was shorter as well: 2.5 days (IQR = 0 to 6.4 days) versus 4.8 days (IQR = 0 to 121.5 days; P = 0.04). The calculated cost reduction was €5000 per extracorporeal membrane oxygenation run. There were no significant differences in mortality. Patients in the HF group needed fewer blood transfusions: 0.9 mL/kg/day (IQR = 0.2 to 2.7 mL/kg/day) versus 1.8 mL/kg/day (IQR = 0.8 to 2.9 mL/kg/day) in the control group (P< 0.001). Consequently the number of blood units used was significantly lower in the HF group (P< 0.001). There was no significant difference in inotropic support or other fluid resuscitation.ConclusionsAdding continuous haemofiltration to the extracorporeal membrane oxygenation circuit in newborns improves outcome by significantly reducing time on extracorporeal membrane oxygenation and on mechanical ventilation, because of better fluid management and a possible reduction of capillary leakage syndrome. Fewer blood transfusions are needed. All in all, overall costs per extracorporeal membrane oxygenation run will be lower.

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“…In humans, CPB induced the release of the protease enzymes lactoferrin, elastase and α‐proteinase from granulocytes [16]. Furthermore, Stahl et al [17] demonstrated that the level of elastase correlated positively with the duration of CPB. Cavarocchi et al [18] found that CPB was associated with an increase in H 2 O 2 in plasma.…”

Section: Introductionmentioning

confidence: 99%

Changes in adhesion molecule expression and oxidative burst activity of granulocytes and monocytes during open-heart surgery with cardiopulmonary bypass compared with abdominal surgery

Toft

Nielsen²,

Tønnesen

et al. 1998

Eur J Anaesthesiol

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Cardiac and major abdominal surgery are associated with granulocytosis in peripheral blood. The purpose of the present study was to describe the granulocyte and monocyte oxidative burst and the expression of adhesion molecules following cardiac surgery with cardiopulmonary bypass and abdominal surgery. The ability to respond with an oxidative burst was measured by means of flow cytometry using 123-dihydrorhodamine. The adhesion molecules CD11a/CD18, CD11c/CD18, CD44 were measured using monoclonal antibodies. Blood samples from eight patients undergoing open-heart surgery were taken before surgery, 1, 5, 10 and 20 min after aortic clamping, and then 1, 5, 10 and 20 min and 1, 2 and 3 h after declamping. Samples from eight patients undergoing abdominal surgery were taken before surgery, at the end of surgery, and 2 and 3 h post-operatively. A decrease in number of granulocytes and monocytes during cardiopulmonary bypass was observed. The percentage of CD11a-positive granulocytes increased from 30% pre-operatively to 75% following cardiopulmonary bypass, while CD44-positive granulocytes increased from 5% to 13%. Despite the extent of the changes, these were not significant. The oxidative burst of the granulocytes and monocytes decreased after declamping to 15% and 27% of initial values in vitro. Several hours after surgery, there was no significant difference between the two groups. These results can be explained by a granulocyte and monocyte refractory response developing subsequent to an increased per-operative oxidative burst activity, and the induction of adhesion molecules on granulocytes associated with the cardiopulmonary bypass and surgery. In conclusion, open-heart surgery with cardiopulmonary bypass was associated with a rapid and pronounced activation of leukocytes which may play a role in reperfusion injury.

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Effects of simulated extracorporeal circulation on human leukocyte elastase release, superoxide generation, and procoagulant activity

Cited by 53 publications

References 30 publications

Enhanced Responsiveness of Circulatory Neutrophils After Cardiopulmonary Bypass: Increased Aggregability and Superoxide Producing Capacity

Enhanced Responsiveness of Circulatory Neutrophils After Cardiopulmonary Bypass: Increased Aggregability and Superoxide Producing Capacity

Haemofiltration in newborns treated with extracorporeal membrane oxygenation: a case-comparison study

Changes in adhesion molecule expression and oxidative burst activity of granulocytes and monocytes during open-heart surgery with cardiopulmonary bypass compared with abdominal surgery

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