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Brazilian Journal of Clinical Medicine and Review

Health Review

Vol. 4 No. 1 (2026): January/December - 2026

Influence of Extracorporeal Circulation on The Inflammatory Cascade

DOI
https://doi.org/10.52600/2965-0968.bjcmr.2026.4.1.bjcmr68
Submitted
April 16, 2026
Published
2026-07-07

Abstract

Extracorporeal circulation (ECC) represents a major technological advance in modern cardiac surgery, enabling complex procedures by temporarily replacing cardiac and pulmonary functions. However, its use is closely associated with a multifactorial systemic inflammatory response that contributes to several postoperative complications, such as multiple organ dysfunction, bleeding, acute kidney injury, neurological changes, and pulmonary inflammation. This narrative literature review aimed to analyze the main pathophysiological mechanisms involved in the inflammatory activation induced by ECC, as well as to discuss strategies for modulating this response. Topics addressed include activation of the complement system, release of pro-inflammatory cytokines (such as IL-6 and TNF-α), leukocyte recruitment, and the impact of mechanical, hemodynamic, and biochemical factors occurring during the procedure. Furthermore, the study explores technological advances aimed at mitigating these effects, including the use of heparin-coated circuits, biocompatible membrane oxygenators, cytokine hemoadsorption, thermal control, pharmacological strategies with corticosteroids, anti-inflammatory agents and antioxidants, as well as minimally invasive approaches (MiECC) and individualized nutritional support. The rational use of these strategies is essential to reduce morbidity and mortality, shorten hospital stays, and improve clinical outcomes in patients undergoing cardiac surgery with ECC. This review also highlights the need for further clinical studies to support greater standardization of therapeutic approaches, especially regarding drug selection, optimal ECC duration, the impact of circuit coatings, and interdisciplinary integration between perfusionists, surgical teams, and intensive care providers. A multidisciplinary approach is key to developing safer, more effective, and personalized practices. The data synthesized here reinforces the critical role of understanding inflammatory mechanisms and implementing advanced technologies and nutritional interventions as strategies to optimize surgical patient care.

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