ECMO is associated with an endotoxin-related, generalized inflammatory state. "The pulmonary, renal, and cardiac dysfunctions documented with prolonged bypass can all be related to a classic sepsis syndrome."
"Endotoxemia may indirectly activate the inflammatory cascade. Splanchnic hypoperfusion, a common finding during and following CPB may damage the mucosal barrier, allowing gut translocation of endotoxin. Systemic endotoxin concentrations correlate closely with the degree of cardiovascular dysfunction following CPB."
"CPB may specifically activate the inflammatory response via at least three distinct mechanisms.One mechanism involves direct “contact activation” of the immune system following exposure of blood to the foreign surfaces of the CPB circuit. A second mechanism involves ischemia–reperfusion injury to the brain, heart, lungs, kidney, and liver as a result of aortic cross-clamping. Restoration of perfusion on release of the aortic cross-clamp is associated with activation of key indices of the inflammatory response."
"Endotoxin is a potent trigger of the inflammatory response."
"Cardiac surgery is associated with endotoxemia and a marked acute-phase response. Therefore, endotoxin must be regarded as a pathophysiologic mediator. The role of the gut as a source of endotoxemia following cardiac surgery deserves further attention."
"Sepsis occurs in response to an infection. When sepsis is not recognized early and managed promptly, it can lead to septic shock, multiple organ failure and death. Patients who are critically ill with severe COVID-19 and other infectious diseases are at higher risk of developing and dying from sepsis."