Background: Even with the use of extracorporeal membrane oxygenation (ECMO) in acute respiratory distress syndrome (ARDS), mortality remainshigh. Also, prognostication of patients with ARDS and ECMO is difficult.Cytokines are thought to be markers of inflammation in both ARDS and in ECMO, however, understanding is limited. We aimed to study the association of threeserum cytokine levels with mortality in these patients with ARDS on ECMO. Methods: We performed a retrospective chart review of ARDS patients on ECMO between 2011 and 2017. Patients with serum TNF-α,IL-6 and IL-2 measured while on ECMO were included, with measurements recordedweekly up to a maximum of 4 measurements. A multivariable regression analysiswas performed and generalizing estimating equations were used to analyze longitudinaltrend of cytokines with mortality. Results: There were 47 patients withARDS on ECMO, of which 31 (68.9%) survived at 30 days and 2 were lost to followup. Initial IL-2 levels were found to be significantly higher among those whowere alive compared to those who died at 30 days (2720 ± 2432 pg/ml vs. 1293 ±693 pg/ml); p = 0.0460. At any given time, an increase in IL-2 was associated with a decrease inodds of death at 30 days (adjusted odds ratio 0.98, 95% confidence interval 0.97- 0.99, p = 0.08). There was no significant difference in average or initiallevels of TNF-α and IL-6 among thosewho were alive vs. those who died at 30 days. There was no association between either ofthese cytokine levels with death while on ECMO. Conclusions: Higherlevels of cytokine IL-2 were associated with lower 30-day mortality. Furtherstudies are needed to elucidate the pathobiology of cytokines while on ECMO andtheir use in predicting outcomes.
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