The systemic inflammatory response to cardiopulmonary bypass: a narrative review

The cardiopulmonary bypass (CPB) is a standard technique in many cardiac interventions. It may elicit a systemic inflammatory response that, fortunately, often remains subclinical and resolves quickly after the CPB stops. However, in some patients, this systemic inflammatory response may be extreme and progress to a systemic inflammatory response syndrome (SIRS). The latter may give rise to significant adverse events and even death. Possible provocations for this syndrome include a contact of blood with the artificial CPB-surface, ischemia-reperfusion injury, endotoxemia and surgical trauma. Many authors have tried to curb this inflammation and improve clinical outcomes, with variable degrees of success. This narrative review provides readers with a brief and up-to-date knowledge concerning the pathophysiology and therapeutic options of this syndrome.