Effects of arteriovenous extracorporeal therapy on hemodynamic stability, ventilation, and oxygenation in normal lambs

Sussmane, Jeffrey B.; Totapally, Balagangadhar; Hultquist, Karl; Torbati, Dan; Wolfsdorf, Jack

doi:10.1097/00003246-200110000-00020

Cited by 14 publications

(8 citation statements)

References 22 publications

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“…Finally severe hypocapnia is uncommon in clinical situations with experienced clinicians and careful monitoring; however, it is certainly possible to develop severe hypocapnia with the institution of extracorporeal membrane oxygenation and HFO in critically ill children or during cardiopulmonary bypass. [6][7][8]25 C Co on nc cl lu us si io on n In this experimental model of superior mesenteric artery IR injury, hypocapnia achieved by HFO ventilation although directly injurious to the liver, attenuated reperfusion bowel injury. R Re ef fe er re en nc ce es s ) was measured at four time points: baseline, 40 min, 120 min, and 180 min.…”

Section: Limitations Of Studymentioning

confidence: 74%

Hypocapnia attenuates mesenteric ischemia-reperfusion injury in a rat model

Duggan

Engelberts

Jankov

et al. 2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Hypocapnia, a recognized complication of high frequency oscillation ventilation, has multiple adverse effects on lung and brain physiology in vivo, including potentiation of free radical injury. We hypothesized that hypocapnia would potentiate the effects of mesenteric ischemia-reperfusion on bowel, liver and lung injury.M Me et th ho od ds s: : Anesthetized male Sprague-Dawley rats were ventilated with high frequency oscillation and were randomized to one of four groups, exposed to either mesenteric ischemia-reperfusion or sham surgery, and to either hypocapnia or normocapnia.R Re es su ul lt ts s: : All animals survived the protocol. Ischemia-reperfusion caused significant histologic bowel injury. Bowel 8-isoprostane generation was greater in ischemia-reperfusion vs sham, but was attenuated by hypocapnia. Laser-Doppler flow studies of bowel perfusion confirmed that hypocapnia attenuated reperfusion following ischemia. Plasma alanine transaminase, reflecting overall hepatocellular injury, was not increased by ischemia-reperfusion but was increased by hypocapnia; however, hepatic isoprostane generation was increased by ischemia-reperfusion, and not by hypocapnia. Oxygenation was comparable in all groups, and compliance was impaired by ischemia-reperfusion but not by hypocapnia.C Co on nc cl lu us si io on n: : Hypocapnia, although directly injurious to the liver, attenuates ischemia-reperfusion induced lipid peroxidation in the bowel, possibly through attenuation of blood flow during reperfusion. Objectif

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Section: Limitations Of Studymentioning

confidence: 74%

Hypocapnia attenuates mesenteric ischemia-reperfusion injury in a rat model

Duggan

Engelberts

Jankov

et al. 2005

Can J Anesth/J Can Anesth

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“…The efficacy of carbon dioxide removal and oxygenation of the Minimax hollow fiber oxygenator were previously studied in our laboratory using 15% AV shunt during stepwise decreases in minute ventilation and oxygenation with gas flow of 1 l/min [17]. This gas flow was approximately four times the maximum blood flow through the AV shunt and maintained normocapnia with a 50% reduction in minute ventilation [17]. In the present study, the oxygenator's gas flow was kept constant at 1 l/min of 100% oxygen and was controlled by an in-line gas regulator (Servo pressure limited system; Hudson RCI, Temecula, CA, USA).…”

Section: Methodsmentioning

confidence: 99%

“…Animal models of AV-ECMO without acute lung injury (ALI) show clinically acceptable cardiorespiratory stability [17-21], whereas models with ALI usually require inotropic and fluid support [13,22-26]. Conrad and coworkers [27], following a series of preclinical studies [14,23-25], evaluated the safety and efficacy of AV-ECMO therapy in a phase I clinical study.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, we demonstrated that lambs with normal lungs are able to maintain effective CO and provide efficient ventilator support with a relatively moderate AV shunt of 15% [17]. The aim of the present study was to determine the cardiovascular support needed to maintain hemodynamic stability and the minute ventilation needed to maintain normocapnia in lambs subjected to severe ALI and treated with AV-ECMO (AV shunt flow of up to 15%) or conventional mechanical ventilation (CMV; AV shunt flow of 0%).…”

Section: Introductionmentioning

confidence: 99%

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et al. 2004

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Introduction Clinical application of arteriovenous (AV) extracorporeal membrane oxygenation (ECMO) requires assessment of cardiovascular ability to respond adequately to the presence of an AV shunt in the face of acute lung injury (ALI). This ability may be age dependent and vary with the experimental model. We studied cardiovascular stability in a lamb model of severe ALI, comparing conventional mechanical ventilation (CMV) with AV-ECMO therapy. Methods Seventeen lambs were anesthetized, tracheotomized, paralyzed, and ventilated to maintain normocapnia. Femoral and jugular veins, and femoral and carotid arteries were instrumented for the AV-ECMO circuit, systemic and pulmonary artery blood pressure monitoring, gas exchange, and cardiac output determination (thermodilution technique). A severe ALI (arterial oxygen tension/inspired fractional oxygen <200) was induced by lung lavage (repeated three times, each with 5 ml/kg saline) followed by tracheal instillation of 2.5 ml/kg of 0.1 N HCl. Lambs were consecutively assigned to CMV treatment (n = 8) or CMV plus AV-ECMO therapy using up to 15% of the cardiac output for the AV shunt flow during a 6-hour study period (n = 9). The outcome measures were the degree of inotropic and ventilator support needed to maintain hemodynamic stability and normocapnia, respectively. Results Five of the nine lambs subjected to AV-ECMO therapy (56%) died before completion of the 6-hour study period, as compared with two out of eight lambs (25%) in the CMV group (P > 0.05; Fisher's exact test). Surviving and nonsurviving lambs in the AV-ECMO group, unlike the CMV group, required continuous volume expansion and inotropic support (P < 0.001; Fisher's exact test). Lambs in the AV-ECMO group were able to maintain normocapnia with a maximum of 30% reduction in the minute ventilation, as compared with the CMV group (P < 0.05). Conclusion AV-ECMO therapy in lambs subjected to severe ALI requires continuous hemodynamic support to maintain cardiovascular stability and normocapnia, as compared with lambs receiving CMV support.

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“…Limiting factors are the oxygencarrying capacity of the arterial blood and the maximal blood flow rate through the membrane lung, which peaks at 30% of cardiac output. 15 Nevertheless, early clinical observations reported improvements in oxygenation. 16 Because AV-ECLA provides effective CO 2 elimination, dissociation of ventilation (AV-ECLA) and oxygenation (respirator) is possible.…”

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confidence: 99%