Effect of venovenous extracorporeal membrane oxygenation on the heart in a healthy piglet model

Shen, Juanhong; Yu, Wenkui; Shi, Jianjun; Chen, Qiyi; Hu, Yimin; Zhang, Juanjuan; Gao, Tao; Xi, Fengchan; Gong, Jianfeng; He, Changsheng; Li, Ning; Li, Jieshou

doi:10.1186/1749-8090-8-163

Cited by 13 publications

(10 citation statements)

References 37 publications

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“…Our previous research suggested that immune mediated inflammation occurs 2 h after initiating ECMO therapy. After 24 h of ECMO therapy, multiple organs, such as the kidney, brain, and myocardium, upregulated expression of inflammatory cytokine [ 12 - 14 ]. In addition, a few rare clinical case reports suggest that ECMO therapy may increase serum endotoxin [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

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The influence of extracorporeal membrane oxygenation therapy on intestinal mucosal barrier in a porcine model for post-traumatic acute respiratory distress syndrome

Chen

Zhu

et al. 2015

J Cardiothorac Surg

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BackgroundIt is unclear at present whether extracorporeal membrane oxygenation (ECMO) therapy can improve intestinal mucous barrier function through increased perfusion. The present study establishes an animal model for post-traumatic acute respiratory distress syndrome (ARDS) and evaluates the effect of v-vECMO treatment on the intestinal mucosal barrier.MethodPulmonary contusion combined with ischemia-reperfusion injury was induced in 30 piglets. The animals were randomly divided into control, model, and ECMO groups. Serum I-FABP, d-lactate, and endotoxin were measured over a 24-h period. The jejunum and colon were collected post-mortem and evaluated histopathologically. The tissue was also examined using electron microscopy, and intestinal tight junction proteins (ZO-1 and occludin) were measured after 24 h of ECMO therapy. Mortality rate and cause of death were also recorded.ResultsThe serum markers evaluating the intestinal mucosal barrier deteriorated in the model group compared to the control group (p < 0.05). At 2 h, serum I-FABP, d-lactate, and endotoxin were significantly increased in the ECMO group compared to the model group (p < 0.05). At 12 h, I-FABP and d-lactate in the ECMO group dropped to model group levels. Serum d-lactate was slightly lower in the ECMO group (p > 0.05) and serum I-FABP was significantly lower than in the model group (p < 0.05) at 24 h. Similarly, serum endotoxin was slightly lower in the ECMO group than in the model group (p > 0.05) at 24 h. After 24 h of ECMO therapy, the occludin and ZO-1 protein concentrations in jejunum and colon mucosa increased moderately compared to that in the model group (p < 0.05). Morphologic structure of the jejunum and colon did not improved significantly after ECMO therapy. Finally, we observed that ECMO therapy moderately decreased mortality (25% vs. 50%).ConclusionIntestinal mucosal barrier continued to deteriorate in the model group. Although early ECMO therapy aggravates intestinal mucosal injury, the damage gradually improves later during therapy. The results show that ECMO therapy has a protective effect on the intestinal mucosal barrier in the later treatment stage.

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Section: Discussionmentioning

confidence: 99%

“…ECMO is a relatively new technology; therefore, further research is needed to ascertain its clinical utility. Our previous studies revealed that ECMO therapy may injure the heart [ 12 , 13 ], kidney [ 14 ], and brain [ 15 ]. Other recent case reports show that ECMO therapy can increase intra-abdominal pressure [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

The influence of extracorporeal membrane oxygenation therapy on intestinal mucosal barrier in a porcine model for post-traumatic acute respiratory distress syndrome

Chen

Zhu

et al. 2015

J Cardiothorac Surg

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“…Levels of pro-in ammatory cytokines rise rapidly [20][21][22], which, in association with activation of the complement and contact systems, results in leukocyte activation [23]. This innate immune response, if severe, persistent or unchecked by a compensatory anti-in ammatory response (CARS), may lead to endothelial injury, disrupted microcirculation, and end organ dysfunction [24,25]. Under the condition of good perfusion of main organs and tissues, according to the histopathological evaluation of our experiment, we found that the in ammatory reaction caused by ECMO circuit itself may be at a low level, it had little effect on the function of main organs and tissues in sheep.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Stability of a Long Term “Awake” Extracorporeal Membrane Oxygenation Model in Large Animal

Gao

Liu

et al. 2021

Preprint

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Background: Extracorporeal membrane oxygenation (ECMO) is rapidly becoming a mainstream technology for lung or heart/lung support especially during the COVID-19 pandemic. “Awake ECMO”is frequently used to indicate an alternative approach of using ECMO without invasive mechanical ventilation, and it has the unique advantages of application. In this study, we explored the feasibility and stability of the establishment method and management strategy of long-term awake ECMO model in healthy sheep. As the sheep are healthy, according to the histopathological analysis , we explored the effect of ECMO circuit itself on organs and tissues. As a preclinical study in large animals, our study aims to provide clues for further research on application expansion, management strategy optimization, pathophysiology exploration, equipment development and subsequent establishment of the disease animal model.Methods: Ten healthy sheep were treated with awake veno-arterial (V-A) or veno-venous (V-V) ECMO for 7 days. They were transferred into the monitoring cages after operation and were ambulatory after anesthesia recovery. ECMO configurations, hemodynamic and hematologic parameters were measured every day. Necropsy was conducted at the endpoint of the experiment to visualize the cannula position in vivo and to examine cannulation related injury and thrombus formation in blood vessels and major organs. Main organs and blood vessels were harvested for pathological investigation.Results: All sheep survived to the end of the experiment (the 7th day). In the whole process of the experiment, the vital signs of which were stable, and no serious bleeding and coagulation events occurred. Hemoglobin concentration and platelet count were in normal reference range, plasma free hemoglobin concentration was maintained at a low level. ECMO flow was stable, and oxygenation performance of oxygenator was satisfied. There was no major adverse pathological injury occurred.Conclusions: Long term awake extracorporeal membrane oxygenation model in large animal is feasible and stable. Perioperative management is the key to the success of this model. As a basic research, it can also provide an alternative strategy for mechanical circulatory support in patients with awake ECMO indications.

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“…22 Indeed, in another preclinical model, the use of V-V ECMO was associated with mild myocardium injury, which had no effect on cardiac performance. 23 Further studies are needed to clarify the effects of extracorporeal circulation on RV function and its clinical implications.…”

Section: Discussionmentioning

confidence: 99%

Effect of ultraprotective mechanical ventilation on right ventricular function during extracorporeal membrane oxygenation in adults with acute respiratory distress syndrome

Pettenuzzo

Pichette

Doufl

et al. 2020

Preprint

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Background: Right ventricular dysfunction (RVD) is frequent in patients suffering from acute respiratory distress syndrome (ARDS). Veno-venous extracorporeal membrane oxygenation (V-V ECMO) may allow the use of ultraprotective mechanical ventilation (MV) in the most severe cases of ARDS. However, the effects of this MV strategy on RV function are not well known. We investigated with echocardiography the prevalence and evolution of RVD in patients supported with V-V ECMO for severe ARDS and ventilated with an ultraprotective ventilation approach. Methods: Eighteen patients who required V-V ECMO for severe ARDS and were assessed with echocardiography before and after cannulation between January 2014 and December 2017 were enrolled in this retrospective observational study. Results: Before cannulation, RV dilatation was present in 6/16 (37%) and 10/17 (59%) patients, according to quantitative and qualitative assessment, respectively, and RVD was reported in 9/14 (64%) patients. After cannulation, tidal volume, plateau pressure, and driving pressure significantly decreased [median (interquartile range) values were 2.0 (0.9-3.6) mL/kg, 20 (20-20) cmH2O, and 10 (10-10) cmH2O, respectively] and RV size and function were similar as before cannulation. Except for SaO2 before cannulation, which was significantly lower in non-survivors, no other risk factor for RVD, RV dilatation, or mortality was identified in our population. Conclusions: In patients requiring V-V ECMO for severe ARDS, RVD and dilatation before ECMO cannulation were frequent but not associated with worse clinical outcomes. An ultraprotective MV strategy was not accompanied by a worsening of RV function.

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Effect of venovenous extracorporeal membrane oxygenation on the heart in a healthy piglet model

Cited by 13 publications

References 37 publications

The influence of extracorporeal membrane oxygenation therapy on intestinal mucosal barrier in a porcine model for post-traumatic acute respiratory distress syndrome

The influence of extracorporeal membrane oxygenation therapy on intestinal mucosal barrier in a porcine model for post-traumatic acute respiratory distress syndrome

Feasibility and Stability of a Long Term “Awake” Extracorporeal Membrane Oxygenation Model in Large Animal

Effect of ultraprotective mechanical ventilation on right ventricular function during extracorporeal membrane oxygenation in adults with acute respiratory distress syndrome

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