Effect of extracorporeal life support on cerebral blood flow, metabolism and electrophysiology in normothermic cats

Iijima, Takehiko; Back, Tobias; Hossmann, K.‐A.

doi:10.1007/bf02425152

Cited by 6 publications

(3 citation statements)

References 25 publications

(24 reference statements)

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“…Partial cardiopulmonary bypass (or partial cardiopulmonary support 20 ) is routinely used in clinical practice for extracorporeal life support in humans and sometimes also for experimental resuscitation. [21][22][23][24][25] Although intra-arterial administration of medication (eg, epinephrine) should be practiced with caution, the low doses used in the model can be further reduced when donor blood is used (such as in group 2), because the withdrawn donor blood and predetermined dose of medication need not be infused after ROSC is observed. As an experimental approach, our intraaortic blood infusion proves to be a very reliable method for remotely controlled resuscitation after prolonged cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

A Reproducible Model of Circulatory Arrest and Remote Resuscitation in Rats for NMR Investigation

Liachenko

Tang

Hamilton

et al. 1998

Stroke

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Background and Purpose-Because noninvasive physiological monitoring of cerebral blood flow, metabolic integrity, and brain ion and water homeostasis can now be accomplished with new, state-of-the-art MR spectroscopy and imaging techniques, it is appropriate to develop controllable and reproducible animal models that permit prolonged circulatory arrest and resuscitation in the magnet and also allow for studies of long-term survival and outcome. We have developed such a model in rats that involves minimal surgical preparations and can achieve resuscitation remotely within precisely controlled time. Methods-Cardiac arrest was induced by asphyxiation, the duration of which ranged from 8 to 24 minutes. Resuscitation was achieved remotely by a slow, intra-aortic infusion of oxygenated blood (withdrawn either from the same rat before asphyxia or from a healthy donor rat) along with a resuscitation cocktail containing heparin (50 U/100 g), sodium bicarbonate (0.1 mEq/100 g), and epinephrine (4 g/100 g). The body temperature was measured by a tympanic thermocouple probe and was controlled either by a heating pad (constant tympanic temperatureϭ37°C) or by warm ambient air (constant air temperatureϭ37°C). Interleaved 31 P/ 1 H nuclear magnetic resonance (NMR) spectroscopy was used in a selected group of rats to measure the cerebral metabolism before and during approximately 20 minutes of circulatory arrest and after resuscitation. Results-The overall success rate of resuscitation, irrespective of the duration of cardiac arrest, was 82% (51 of 62). With a programmed infusion pump, the success rate was even higher (95%). The survival time for rats subjected to 15 and 19 minutes of asphyxia with core temperature tightly controlled was significantly lower than that with ambient temperature control (PϽ0.001 and PϽ0.04, respectively). High-quality NMR spectra can be obtained continuously without interference from the resuscitation effort. Final histological examinations taken 5 days after resuscitation showed typical neuronal damages, similar to those found in other global ischemia models. Conclusions-Because the no-flow time and resuscitation time can be precisely controlled, this outcome model is ideally suited for studies of ischemic and reperfusion injuries in the brain and possibly in other critical organs, permitting continuous assessment of long-term recovery and follow-up in the same animals. (Stroke. 1998;29:1229-1239.)

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Section: Discussionmentioning

confidence: 99%

A Reproducible Model of Circulatory Arrest and Remote Resuscitation in Rats for NMR Investigation

Liachenko

Tang

Hamilton

et al. 1998

Stroke

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“…25 Early animal studies noted decreased cerebral oxygenation, altered cerebral autoregulation, and increased lactate despite normotension with extracorporeal life support. 20, 35 Barrett et al found acute neurological injury in 22% of pediatric patients undergoing ECPR from their retrospective review of the Extracorporeal Life Support Organization registry. They noted that lack of metabolic acidosis and underlying cardiac disease decreased the odds of neurological injury.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation for cardiac arrest during moyamoya cerebral revascularization surgery: case report

Choudhri

Shah

Basarab-Tung

et al. 2015

JNS

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C ardiopulmonary bypass using the heart-lung machine was initiated in 1937 by Gibbons and subsequently has been used for open cardiac surgery since 1954. 15 However, given the limitations of membrane oxygenation, it could not be used for long durations. 41 This gave way to the development of extracorporeal membrane oxygenation (ECMO) in 1972 by Hill et al. 18,31 ECMO is a last-resort intensive care technique indicated during cardiopulmonary failure due to potentially reversible causes. ECMO provides circulatory support by assuming the role of the heart and lungs to maintain blood flow and oxygenation to the vital organs, including the brain.14 Most data on the success of ECMO come from its primary indication for respiratory failure in newborns. Four prospective randomized controlled trials in newborns and one in adults have shown a significant survival advantage with ECMO for severe respiratory distress. 11,29 The data and indications for ECMO in the setting of cardiac failure are still evolving. Conventional extracorporeal circuits are routinely used in elective cardiac surgery where the right atrium and aorta are directly cannulated to allow unobstructed flow. 15Although ECMO is derived from cardiopulmonary bypass, differences between them include minimal heparin use, peripheral cannulation, lack of a cardiotomy reservoir, and no autotransfusion. Since these early developments, ECMO has transiabbreviatioNs CPR = cardiopulmonary resuscitation; EC-IC = extracranial-to-intracranial; ECMO = extracorporeal membrane oxygenation; ECPR = extracorporeal CPR; MMD = moyamoya disease; VA = venoarterial; VV = veno-venous. The authors describe the case of a 51-year-old man with bilateral moyamoya disease and prior strokes who developed an asystolic cardiac arrest while undergoing revascularization surgery under mild hypothermia. The patient was successfully treated with venoarterial (VA) extracorporeal membrane oxygenation (ECMO) after manual cardiopulmonary resuscitation (CPR) was unsuccessful for 45 minutes. ECMO is a cardiopulmonary support system that is indicated for respiratory failure in pediatric and adult patients. It is increasingly being used as an extension to mechanical CPR for patients who have suffered cardiac arrest if the underlying cause of cardiac arrest is thought to be reversible. Identifying which patients should be placed on emergency ECMO after cardiac arrest is controversial given its high morbidity and mortality. ECMO in neurosurgical settings has associated risks of intracranial hemorrhage and neurological compromise, while resource utilization is paramount given the high costs of this treatment. This paper is significant because it describes the use of ECMO in an unindicated setting. Limited data are available for ECMO usage after cardiac arrest with baseline cerebral ischemia. Furthermore, this paper raises important considerations for extracorporeal CPR use in a patient who had recently undergone craniotomy. The patient in this report remained on ECMO for 48 hours, after which he was successfu...

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“…In addition, the test rig was constructed to produce very small virus aerosol droplets. The short duration of the exposure period was considered adequate because earlier studies had shown that filtration efficiency does not diminish for at least 24 hours [14], [15], [16], [17]. The filtration efficiency of mechanical filters actually tends to increase over time as the substances retained on the filter form a layer (“filter cake”), which gradually increases particle retention.…”

Section: Discussionmentioning

confidence: 99%

Can breathing circuit filters help prevent the spread of influenza A (H1N1) virus from intubated patients?

Heuer

Crozier²,

Howard³

et al. 2013

GMS Hygiene and Infection Control; 8(1):Doc09; ISSN 2196-5226

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Effect of extracorporeal life support on cerebral blood flow, metabolism and electrophysiology in normothermic cats

Abstract: These data demonstrate that ECLS is associated with reduced cerebral oxygen delivery and may cause brain hypoxia despite normal blood pressure. This complication may contribute to the high incidence of neurological disturbances after prolonged ECLS.

Cited by 6 publications

References 25 publications

A Reproducible Model of Circulatory Arrest and Remote Resuscitation in Rats for NMR Investigation

A Reproducible Model of Circulatory Arrest and Remote Resuscitation in Rats for NMR Investigation

Extracorporeal membrane oxygenation for cardiac arrest during moyamoya cerebral revascularization surgery: case report

Can breathing circuit filters help prevent the spread of influenza A (H1N1) virus from intubated patients?

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