Extracorporeal life support (ECLS) encompasses a wide range of extracorporeal modalities that offer short- and intermediate-term mechanical support to the failing heart or lung. Apart from the daily use of cardiopulmonary bypass (CPB) in the operating room, there has been a resurgence of interest and utilization of veno-arterial and veno-venous extracorporeal membrane oxygenation (VA- and VV-ECMO, respectively) and extracorporeal carbon dioxide removal (ECCO2R) in recent years. This might be attributed to the advancement in technology, nonetheless the morbidity and mortality associated with the clinical application of this technology is still significant. The initiation of ECLS triggers a systemic inflammatory response, which involves the activation of the coagulation cascade, complement systems, endothelial cells, leukocytes, and platelets, thus potentially contributing to morbidity and mortality. This is due to the release of cytokines and other biomarkers of inflammation, which have been associated with multiorgan dysfunction. On the other hand, ECLS can be utilized as a therapy to halt the inflammatory response associated with critical illness and ICU therapeutic intervention, such as facilitating ultra-protective mechanical ventilation. In addition to addressing the impact on outcome of the relationship between inflammation and ECLS, two different but complementary pathophysiological perspectives will be developed in this review: ECLS as the cause of inflammation and ECLS as the treatment of inflammation. This framework may be useful in guiding the development of novel therapeutic strategies to improve the outcome of critical illness.

中文翻译：

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体外生命支持和全身炎症

体外生命支持 (ECLS) 包括多种体外方式，可为衰竭的心脏或肺提供短期和中期机械支持。除了手术室日常使用体外循环 (CPB) 外，对静脉-动脉和静脉-静脉体外膜肺氧合（分别为 VA-ECMO 和 VV-ECMO）和体外二氧化碳的兴趣和利用也重新兴起近年来去除（ECCO2R）。这可能归因于技术的进步，但与该技术的临床应用相关的发病率和死亡率仍然很高。ECLS 的启动引发全身炎症反应，包括凝血级联、补体系统、内皮细胞、白细胞和血小板的激活，因此可能导致发病率和死亡率。这是由于细胞因子和其他炎症生物标志物的释放，它们与多器官功能障碍有关。另一方面，ECLS 可用作一种疗法来阻止与危重疾病和 ICU 治疗干预相关的炎症反应，例如促进超保护性机械通气。除了解决炎症和 ECLS 之间关系对结果的影响之外，本综述还将提出两种不同但互补的病理生理学观点：ECLS 作为炎症的原因，ECLS 作为炎症的治疗方法。该框架可能有助于指导开发新的治疗策略以改善危重疾病的结果。