The Endocrinological Responses of Veno-Venous Extracorporeal Membrane Oxygenation on Hypoxic Fetal Lambs

Abstract

:Objective : The purpose of this study was to observe endocrinological responses of venoarterial and veno -venous extracorporeal membrane oxygenation (V -A and V -V ECMO) to support fetal oxygenation in utero.Methods : An ECMO system with a centrifugal pump was applied to six chronically instrumented fetal lambs, at 126 -134 days of gestation. Blood was obtained through a double -lumen catheter inserted into the right atrium. After oxygenation, the blood was returned through a single -lumen catheter into either the carotid artery (veno -arterial ; V -A ECMO) or the right atrium (V -V ECMO). After fetal hypoxia had been experimentally produced, V -A ECMO or V -V ECMO was instituted to maintain fetal oxygenation. We compared fetal blood gases and concentrations of atrial natriuretic peptide (ANP), epinephrine and norepinephrine with both routes of ECMO.Results : Fetal carotid artery pH did not change during hypoxemia, but decreased after instituting V -A ECMO and V -V ECMO. After instituting V -A ECMO or V -V ECMO for 30 min, oxygen partial pressure (pO2) in the fetal cranial carotid artery recovered from the hypoxic level. The ANP concentration in V -V ECMO was significantly lower than that in V -A ECMO. Fetal serum epinephrine and norepinephrine concentrations significantly increased in association with hypoxic stimulation. There was a further increase in fetal serum epinephrine concentration after instituting V -A ECMO. No significant difference in concentration was found after instituting V -V ECMO from that of after the institution of V -A ECMO.Conclusions : This study suggested that V -V ECMO may possibly be less invasive than V -A ECMO for fetal heart, because ANP, a cardiac distress index, was lower in V -V ECMO than in V -A ECMO.

Incidence of Acute Kidney Injury Is Lower in High-Risk Patients Undergoing Percutaneous Coronary Intervention Supported with Impella Compared to ECMO

“…This ECMO-dependent effect on afterload is known to require venting in order to relieve the resulting wall stress [26,36]. Reflecting this atrial stretch, serum ANP is increased after VA-ECMO treatment [32,37]. Normally, ANP signaling ceases upon the alleviation of atrial stretch (resulting from natriuresis).…”