The effect of hyperoxia on inflammation and platelet responses in an ex vivo extracorporeal membrane oxygenation circuit

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Author(s)
Passmore, MR
Ki, KK
Chan, CHH
Lee, T
Bouquet, M
Wood, ES
Raman, S
Rozencwajg, S
Burrell, AJC
McDonald, CI
Langguth, D
Shekar, K
Malfertheiner, MV
Fraser, JF
Suen, JY
Griffith University Author(s)
Year published
2020
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Show full item recordAbstract
Use of extracorporeal membrane oxygenation (ECMO) is expanding, however it is still associated with significant morbidity and mortality. Activation of inflammatory and innate immune responses and hemostatic alterations contribute to complications. Hyperoxia may play a role in exacerbating these responses. Nine ex vivo ECMO circuits were tested using fresh healthy human whole blood, with two oxygen levels: 21% inspired fraction of oxygen (FiO2 ; mild hyperoxia; n=5) and 100% FiO2 (severe hyperoxia; n=4). Serial blood samples were taken for analysis of platelet aggregometry, leukocyte activation, inflammatory and oxidative ...
View more >Use of extracorporeal membrane oxygenation (ECMO) is expanding, however it is still associated with significant morbidity and mortality. Activation of inflammatory and innate immune responses and hemostatic alterations contribute to complications. Hyperoxia may play a role in exacerbating these responses. Nine ex vivo ECMO circuits were tested using fresh healthy human whole blood, with two oxygen levels: 21% inspired fraction of oxygen (FiO2 ; mild hyperoxia; n=5) and 100% FiO2 (severe hyperoxia; n=4). Serial blood samples were taken for analysis of platelet aggregometry, leukocyte activation, inflammatory and oxidative stress markers. ECMO resulted in reduced adenosine diphosphate- (p<0.05) and thrombin receptor activating peptide-induced (p<0.05) platelet aggregation, as well as increasing levels of the neutrophil activation marker, neutrophil elastase (p=0.013). Additionally, levels of the inflammatory chemokine interleukin-8 were elevated (p<0.05) and the activity of superoxide dismutase, a marker of oxidative stress, was increased (p=0.002). Hyperoxia did not augment these responses, with no significant differences detected between mild and severe hyperoxia. Our ex vivo model of ECMO revealed that the circuit itself triggers a pro-inflammatory and oxidative stress response however exposure to supra-physiologic oxygen does not amplify that response. Extended-duration studies and inclusion of an endothelial component could be beneficial in characterizing longer-term changes.
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View more >Use of extracorporeal membrane oxygenation (ECMO) is expanding, however it is still associated with significant morbidity and mortality. Activation of inflammatory and innate immune responses and hemostatic alterations contribute to complications. Hyperoxia may play a role in exacerbating these responses. Nine ex vivo ECMO circuits were tested using fresh healthy human whole blood, with two oxygen levels: 21% inspired fraction of oxygen (FiO2 ; mild hyperoxia; n=5) and 100% FiO2 (severe hyperoxia; n=4). Serial blood samples were taken for analysis of platelet aggregometry, leukocyte activation, inflammatory and oxidative stress markers. ECMO resulted in reduced adenosine diphosphate- (p<0.05) and thrombin receptor activating peptide-induced (p<0.05) platelet aggregation, as well as increasing levels of the neutrophil activation marker, neutrophil elastase (p=0.013). Additionally, levels of the inflammatory chemokine interleukin-8 were elevated (p<0.05) and the activity of superoxide dismutase, a marker of oxidative stress, was increased (p=0.002). Hyperoxia did not augment these responses, with no significant differences detected between mild and severe hyperoxia. Our ex vivo model of ECMO revealed that the circuit itself triggers a pro-inflammatory and oxidative stress response however exposure to supra-physiologic oxygen does not amplify that response. Extended-duration studies and inclusion of an endothelial component could be beneficial in characterizing longer-term changes.
View less >
Journal Title
Artificial Organs
Copyright Statement
© 2020 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc. This is the peer reviewed version of the following article: The effect of hyperoxia on inflammation and platelet responses in an ex vivo extracorporeal membrane oxygenation circuit., Artificial Organs, Artificial Organs, 2020, which has been published in final form at https://doi.org/10.1111/aor.13771. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html)
Subject
Biomedical engineering
Clinical sciences
extracorporeal membrane oxygenation
hyperoxia
inflammation
platelets