ABSTRACT
BACKGROUND Evidence suggests that critically ill COVID-19 patients have a dysregulated host immune response that contributes to end-organ damage. Extracorporeal membrane oxygenation (ECMO) has been utilized in this population with varying degrees of success. This study was performed to evaluate the impact of ECMO on the host immunotranscriptomic response in these patients. METHODS Eleven critically ill COVID-19 patients requiring ECMO underwent an analysis of cytokines and immunotranscriptomic pathways pre-ECMO (T1), after ECMO for 24 hours (T2), and 2 hours after ECMO decannulation (T3). A Multiplex Human Cytokine panel was used to identify cytokine changes and immunotranscriptomic changes in peripheral leukocytes were evaluated by PAXgene and NanoString nCounter. RESULTS Differential gene expression (DGE) of 11 host immune genes was noted at T2 compared to T1. The most significant genes were MD2 and MRC1, which are binding ligands for the activation of toll-like receptors (TLR) 2 and 4. Reactome analyses of DGE demonstrated an impact on many of the body's most important immune inflammatory pathways. CONCLUSIONS These findings suggest a temporal impact of ECMO on the host immunotranscriptomic response in critically ill patients with COVID-19.