Fig. 1

Main VA-ECMO-induced mechanisms of lung damage and dysfunction. Left side: SIRS is initiated by the blood contact with the circuitry surface. It activates humoral cascades, platelets, and leukocytes, leading eventually to EC injury and activated PMN sequestration into the lung parenchyma. Right side: EC injury favors fluid infiltration into both alveolar space and lung parenchyma, leading to pulmonary edema, which is aggravated by the increase of pulmonary vein pressure. Alveolar edema and decreased pulmonary artery perfusion lead to lung parenchymal ischemia which in turn maintains chronic inflammation and promotes neoangiogenesis and fibrosis generation