The effect of venovenous extra-corporeal membrane oxygenation (ECMO) therapy on immune inflammatory response of cerebral tissues in porcine model

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

doi:10.1186/1749-8090-8-186

Cited by 42 publications

(38 citation statements)

References 36 publications

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“…Levels of pro-inflammatory cytokines rise rapidly [13–19], which, in association with activation of the complement and contact systems [20–25], results in leukocyte activation [26–28]. This innate immune response, if severe, persistent or unchecked by a compensatory anti-inflammatory response (CARS) [29], may lead to endothelial injury, disrupted microcirculation, and end-organ dysfunction [30–35]. Despite major improvements in pump and circuit design, oxygenators and the advent of heparin-bonded surfaces, the SIRS response to ECMO remains a clinical concern.…”

Section: The Inflammatory Response To Ecmomentioning

confidence: 99%

The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology

et al. 2016

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Extracorporeal membrane oxygenation (ECMO) is a technology capable of providing short-term mechanical support to the heart, lungs or both. Over the last decade, the number of centres offering ECMO has grown rapidly. At the same time, the indications for its use have also been broadened. In part, this trend has been supported by advances in circuit design and in cannulation techniques. Despite the widespread adoption of extracorporeal life support techniques, the use of ECMO remains associated with significant morbidity and mortality. A complication witnessed during ECMO is the inflammatory response to extracorporeal circulation. This reaction shares similarities with the systemic inflammatory response syndrome (SIRS) and has been well-documented in relation to cardiopulmonary bypass. The exposure of a patient’s blood to the non-endothelialised surface of the ECMO circuit results in the widespread activation of the innate immune system; if unchecked this may result in inflammation and organ injury. Here, we review the pathophysiology of the inflammatory response to ECMO, highlighting the complex interactions between arms of the innate immune response, the endothelium and coagulation. An understanding of the processes involved may guide the design of therapies and strategies aimed at ameliorating inflammation during ECMO. Likewise, an appreciation of the potentially deleterious inflammatory effects of ECMO may assist those weighing the risks and benefits of therapy.

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Section: The Inflammatory Response To Ecmomentioning

confidence: 99%

The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology

et al. 2016

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“…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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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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“…On the other hand, systemic inflammation (e.g., elevated c-reactive protein, elevated pro-inflammatory cytokines) has been documented in neonates with ECMO [30, 31], as well as in neonates with clinical sepsis [32] and studies have demonstrated that creatine is often elevated alongside choline in the setting of cerebral inflammation [25, 27]. Taken together, the elevations in creatine and choline suggest that the systemic inflammatory response could extend to the central nervous system, as demonstrated in animal models [33]. …”

Section: Discussionmentioning

confidence: 99%

The Impact of Venoarterial and Venovenous Extracorporeal Membrane Oxygenation on Cerebral Metabolism in the Newborn Brain

et al. 2016

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BackgroundExtracorporeal membrane oxygenation (ECMO) is an effective therapy for supporting infants with reversible cardiopulmonary failure. Still, survivors are at risk for long-term neurodevelopmental impairments, the cause of which is not fully understood.ObjectiveTo elucidate the effects of ECMO on the newborn brain. We hypothesized that the cerebral metabolic profile of neonates who received ECMO would differ from neonates who did not receive ECMO. To address this, we used magnetic resonance spectroscopy (1H-MRS) to investigate the effects of venoarterial and venovenous ECMO on cerebral metabolism.Methods41 neonates treated with ECMO were contrasted to 38 age-matched neonates.ResultsAll 1H-MRS data were acquired from standardized grey matter and white matter regions of interest using a short-echo (TE = 35 milliseconds), point-resolved spectroscopy sequence (PRESS) and quantitated using LCModel. Metabolite concentrations (mmol/kg) were compared across groups using multivariate analysis of covariance. Elevated creatine (p = 0.002) and choline (p = 0.005) concentrations were observed in the grey matter among neonates treated with ECMO relative to the reference group. Likewise, choline concentrations were elevated in the white matter (p = 0.003) while glutamate was reduced (p = 0.03). Contrasts between ECMO groups revealed lower osmolite concentrations (e.g. myoinositol) among the venovenous ECMO group.ConclusionNeonates who underwent ECMO were found to have an abnormal cerebral metabolic profile, with the pattern of abnormalities suggestive of an underlying inflammatory process. Additionally, neonates who underwent venovenous ECMO had low cerebral osmolite concentrations as seen in vasogenic edema.

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The effect of venovenous extra-corporeal membrane oxygenation (ECMO) therapy on immune inflammatory response of cerebral tissues in porcine model

Cited by 42 publications

References 36 publications

The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology

The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology

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

The Impact of Venoarterial and Venovenous Extracorporeal Membrane Oxygenation on Cerebral Metabolism in the Newborn Brain

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