The Effect of Extracorporeal Membrane Oxygenation Therapy on Systemic Oxidative Stress Injury in a Porcine Model

Abstract

Extracorporeal membrane oxygenation (ECMO) therapy can result in systemic immune inflammation and trigger a hemolytic response, both of which can lead to oxidative stress injury. However, currently, there are few studies about whether ECMO can lead to oxidative stress injury. The objective of this study was to determine the effect of ECMO therapy on systemic oxidative stress. Twelve pigs were randomly divided into control and ECMO treatment groups. Blood samples were collected at -1, 0, 2, 6, 12, and 24 h during ECMO therapy in order to measure the levels of various oxidative stress markers in plasma. All animals included in the study were euthanized after 24 h of ECMO treatment. Malondialdehyde (MDA) was used as a marker of oxidation, and superoxide dismutase (SOD), glutathione (GSH), and total antioxidant capacity (T-AOC) were used as indices for antioxidant activity. The plasma levels of each molecule were similar when measured at -1 and 0 h (P > 0.05). In the control group, MDA, SOD, GSH, and T-AOC remained relatively constant throughout the study period. However, when ECMO was administered for 2 h, plasma levels of MDA increased significantly; conversely, levels of SOD, GSH, and T-AOC decreased. Maximum MDA levels and minimal SOD, GSH, and T-AOC levels were observed after 6 h of ECMO treatment. MDA and SOD levels had returned to baseline at 24 h. At this time-point, levels of MDA and T-AOC in samples from the right frontal cortex and jejunum differed significantly between the control and ECMO treatment groups. These results show that early ECMO treatment can induce significant oxidative stress injury in plasma. However, in the latter stage of the treatment, the oxidative stress injury can be repaired gradually. ECMO treatment can also result in mild oxidative stress injury in the jejunum and brain tissue.

The impact of acute lung injury, ECMO and transfusion on oxidative stress and plasma selenium levels in an ovine model

“…When conventional medicine fails in these patients, ECMO is one of the few remaining life-saving options [4]. Previous ECMO studies in paediatrics [25], rabbits [26], lambs [27], sheep [28] and pigs [29] have shown significant elevations in lipid peroxides. However it is difficult to translate these findings to critically ill adult patients as (i) paediatric patients have significantly different bodyweight to ECMO surface area ratios and (ii) (with the exception of the sheep study [28]) in all the other animal models ECMO was initiated in a healthy host.…”

Neutrophil expression of glucocorticoid-induced leucine zipper (GILZ) anti-inflammatory protein is associated with acute respiratory distress syndrome severity

“…This rescue therapy is used in severe ARDS when conventional mechanical ventilation fails [5, 38]. As ECMO has been shown to have pro-inflammatory effects in vivo [39, 40], it is conceivable that GILZ induction was aimed at compensating for these effects.…”

Systemic PaO2 Oscillations Cause Mild Brain Injury in a Pig Model

“…Furthermore, the present results demonstrate that control group showed an increase in inflammatory markers in comparison to the sham group that can be explained by the ECMO itself applied for a duration of 20 hours. It is well known that ECMO over a long period of time causes systemic and organ inflammation (28). Therefore, it is even more interesting that the effect of Pao 2 oscillations on cerebral inflammation was superimposed to the deleterious effect of ECMO therapy.…”