Effect of the Pulsatile Extracorporeal Membrane Oxygenation on Hemodynamic Energy and Systemic Microcirculation in a Piglet Model of Acute Cardiac Failure

Abstract

The objective of this study was to compare the effects of pulsatile and nonpulsatile extracorporeal membrane oxygenation (ECMO) on hemodynamic energy and systemic microcirculation in an acute cardiac failure model in piglets. Fourteen piglets with a mean body weight of 6.08 ± 0.86 kg were divided into pulsatile (N = 7) and nonpulsatile (N = 7) ECMO groups. The experimental ECMO circuit consisted of a centrifugal pump, a membrane oxygenator, and a pneumatic pulsatile flow generator system developed in‐house. Nonpulsatile ECMO was initiated at a flow rate of 140 mL/kg/min for the first 30 min with normal heart beating, with rectal temperature maintained at 36°C. Ventricular fibrillation was then induced with a 3.5‐V alternating current to generate a cardiac dysfunction model. Using this model, we collected the data on pulsatile and nonpulsatile groups. The piglets were weaned off ECMO at the end of the experiment (180 min after ECMO was initiated). The animals did not receive blood transfusions, inotropic drugs, or vasoactive drugs. Blood samples were collected to measure hemoglobin, methemoglobin, blood gases, electrolytes, and lactic acid levels. Hemodynamic energy was calculated using the Shepard's energy equivalent pressure. Near‐infrared spectroscopy was used to monitor brain and kidney perfusion. The pulsatile ECMO group had a higher atrial pressure (systolic and mean), and significantly higher regional saturation at the brain level, than the nonpulsatile group (for both, P < 0.05). Additionally, the pulsatile ECMO group had higher methemoglobin levels within the normal range than the nonpulsatile group. Our study demonstrated that pulsatile ECMO produces significantly higher hemodynamic energy and improves systemic microcirculation, compared with nonpulsatile ECMO in acute cardiac failure.

Lung–kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup

“…A similar trend, albeit not significant, was also shown in the CESAR trial [99]. However, autoregulation of renal microcirculation may deteriorate during non-pulsatile ECMO as shown in an acute cardiac failure model in pigs [105]. Other factors negatively influencing renal function during ECMO treatment may be fluid overload [106] ischaemia/reperfusion injury [107], and circuit-related factors [108,109].…”

Synchronized Pulsatile Flow With Low Systolic Output From Veno‐Arterial Extracorporeal Membrane Oxygenation Improves Myocardial Recovery After Experimental Cardiac Arrest in Pigs

“…A recent study by Itoh et al using a similar model of pulsatile vaECMO but in pigs remaining in ventricular fibrillation for 180 min, showed improved microcirculation parameters and higher hemodynamic energy in the pulsatile vaECMO group compared to continuous flow vaECMO. This may have also acted in favor of a better LVEF recovery in our study .…”

Improved Outcome in an Animal Model of Prolonged Cardiac Arrest Through Pulsatile High Pressure Controlled Automated Reperfusion of the Whole Body

“…Pulsatile flow may lower pulmonary artery pressures and cause lower endothelial activation and higher anti‐inflammatory cytokines secretion . Other studies have also suggested that pulsatile extracorporeal flow provides superior end‐organ protection with improved renal function and systemic vascular tone possibly through improved systemic microcirculation . Therefore, in this study, we tested a high pulsatile pressure during CARL and the MAP data demonstrated in Figure show that we were able to provide high pressure CARL compared to the low pressure and nonpulsatile flow CARL.…”