Impact of Extracorporeal Membrane Oxygenation Modality on Cytokine Release During Rescue from Infant Hypoxia

Abstract

The treatment of acute respiratory failure in infants by means of extracorporeal membrane oxygenation (ECMO) is thought to be associated with a treatment-related inflammatory reaction, which may deteriorate the underlying disease process. The aim of this study was to compare the venoarterial (VA) and venovenous (VV) modality of ECMO with regard to their pulmonary and serological cytokine release during rescue from acute hypoxia. The inflammatory response was measured in piglets undergoing hypoxic ventilation with a gas mixture of 92% N 2 and 8% O 2 , which were then rescued through VA-(n = 5) or VV-ECMO (n = 5). The effect of cannulation and anesthesia on the inflammatory response was deducted from regularly ventilated control animals (n = 5). The concentrations of the proinflammatory interleukins (IL)-1␤ and IL-8 increased in the bronchoalveolar lavage fluid of all groups over a study period of 5 h but were significantly higher (P < 0.05) during VA-ECMO treatment, whereas the anti-inflammatory IL-10 concentrations were significantly higher in the bronchoalveolar lavage fluid of VV-treated animals (P < 0.001). No statistical difference between groups was found in the serum concentrations of cytokines. We conclude that in this animal model rescue from hypoxia by means of the VA modality of ECMO leads to a more pronounced inflammatory reaction of the lung than when applying the VV modality.

Continuous renal replacement therapy to reduce inflammation in a piglet hemorrhage–reperfusion extracorporeal membrane oxygenation model

“…As in our study, serum IL-1β levels were essentially undetectable. Although their findings implicated the role of the pulmonary system in inflammatory mediator production, they did not make any correlation with clinical well-being, i.e., worsening hemodynamic or oxygen utilization (6). Utilizing the same cytokine markers, we were able to make similar conclusions in our experimental ECMO model.…”

“…In addition, the lung plays a major role as a site of inflammation during extracorporeal therapy (4). Levels of pro-inflammatory cytokines, such as tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, and IL-8, are increased in patients as early as 3-4 h after placement on ECMO and/or cardiopulmonary bypass (CPB) (4)(5)(6)(7)(8).…”

Resuscitation of Hypoxic Piglets with 100% O2 Increases Pulmonary Metalloproteinases and IL-8

“…In clinical studies, increased levels of proinflammatory cytokines (i.e. IL-8) in BAL fluid correlated with the degree of pulmonary dysfunction and predicted development of chronic lung disease in premature infants (33). Importantly, IL-8 level is known to regulate NF-B signaling via a redox-sensitive mechanism (34).…”

Haemodynamic changes and stress responses of piglets to surgery during total intravenous anaesthesia with propofol and fentanyl

“…2 Surgery consisted of the cannulation of blood vessels. The right external jugular vein was surgically exposed and a 10 or 12 Fr BioMedicus ECMO cannula (Medtronic, Anaheim, CA, USA) was introduced and advanced until its tip lay in the right atrium.…”

“…1 Recently, we used piglets to simulate acute respiratory failure in human infants and to investigate different treatment modalities of extracorporeal membrane oxygenation (ECMO). 2 The effects of anaesthetics on the cardiovascular system are profound and complicate the interpretation of haemodynamic data derived from animal models. Total intravenous anaesthesia (TIVA) with propofol and fentanyl has been used in porcine models, 3 -5 but its effect on the stress response has not yet been evaluated in this species.…”