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Golding R, Braun RK, Miller L, Lasarev M, Hacker TA, Rodgers AC, Staehler A, Eldridge MW, Al-Subu A. Differential changes in expression of inflammatory mRNA and protein after oleic acid-induced acute lung injury. Exp Lung Res 2024; 50:96-105. [PMID: 38625585 DOI: 10.1080/01902148.2024.2341099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
Background: Acute Respiratory Distress syndrome (ARDS) is a clinical syndrome of noncardiac pulmonary edema and inflammation leading to acute respiratory failure. We used the oleic acid infusion pig model of ARDS resembling human disease to explore cytokine changes in white blood cells (WBC) and plasma proteins, comparing baseline to ARDS values. Methods: Nineteen juvenile female swine were included in the study. ARDS defined by a PaO2/FiO2 ratio < 300 was induced by continuous oleic acid infusion. Arterial blood was drawn before and during oleic acid infusion, and when ARDS was established. Cytokine expression in WBC was analyzed by RT-qPCR and plasma protein expression by ELISA. Results: The median concentration of IFN-γ mRNA was estimated to be 59% (p = 0.006) and of IL-6 to be 44.4% (p = 0.003) of the baseline amount. No significant changes were detected for TNF-α, IL-17, and IL-10 mRNA expression. In contrast, the concentrations of plasma IFN-γ and IL-6 were significantly higher (p = 0.004 and p = 0.048 resp.), and TNF-α was significantly lower (p = 0.006) at ARDS compared to baseline. Conclusions: The change of proinflammatory cytokines IFN-γ and IL-6 expression is different comparing mRNA and plasma proteins at oleic acid-induced ARDS compared to baseline. The migration of cells to the lung may be the cause for this discrepancy.
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Affiliation(s)
- Regina Golding
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Rudolf K Braun
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lorenzo Miller
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Michael Lasarev
- Department of Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Timothy A Hacker
- Cardiovascular Physiology Core Facility, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Allison C Rodgers
- Cardiovascular Physiology Core Facility, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ava Staehler
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Marlowe W Eldridge
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Awni Al-Subu
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Deininger MM, Benner CF, Strudthoff LJ, Leonhardt S, Bruells CS, Marx G, Bleilevens C, Breuer T. Post-Mortem Extracorporeal Membrane Oxygenation Perfusion Rat Model: A Feasibility Study. Animals (Basel) 2023; 13:3532. [PMID: 38003149 PMCID: PMC10668677 DOI: 10.3390/ani13223532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
The development of biomedical soft- or hardware frequently includes testing in animals. However, large efforts have been made to reduce the number of animal experiments, according to the 3Rs principle. Simultaneously, a significant number of surplus animals are euthanized without scientific necessity. The primary aim of this study was to establish a post-mortem rat perfusion model using extracorporeal membrane oxygenation (ECMO) in surplus rat cadavers and generate first post vivo results concerning the oxygenation performance of a recently developed ECMO membrane oxygenator. Four rats were euthanized and connected post-mortem to a venous-arterial ECMO circulation for up to eight hours. Angiographic perfusion proofs, blood gas analyses and blood oxygenation calculations were performed. The mean preparation time for the ECMO system was 791 ± 29 s and sufficient organ perfusion could be maintained for 463 ± 26 min, proofed via angiographic imaging and a mean femoral arterial pressure of 43 ± 17 mmHg. A stable partial oxygen pressure, a 73% rise in arterial oxygen concentration and an exponentially increasing oxygen extraction ratio up to 4.75 times were shown. Considering the 3Rs, the established post-mortal ECMO perfusion rat model using surplus animals represents a promising alternative to models using live animals. Given the preserved organ perfusion, its use could be conceivable for various biomedical device testing.
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Affiliation(s)
- Matthias Manfred Deininger
- Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (G.M.); (T.B.)
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany;
| | - Carl-Friedrich Benner
- Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (C.-F.B.); (S.L.)
| | - Lasse Johannes Strudthoff
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany;
| | - Steffen Leonhardt
- Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (C.-F.B.); (S.L.)
| | - Christian Simon Bruells
- Department of Anesthesia, Intensive and Emergency Medicine, Marien Kliniken, 57072 Siegen, Germany;
| | - Gernot Marx
- Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (G.M.); (T.B.)
| | - Christian Bleilevens
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany;
| | - Thomas Breuer
- Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (G.M.); (T.B.)
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3
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Strudthoff LJ, Focke J, Hesselmann F, Kaesler A, Martins Costa A, Schlanstein PC, Schmitz-Rode T, Steinseifer U, Steuer NB, Wiegmann B, Arens J, Jansen SV. Novel Size-Variable Dedicated Rodent Oxygenator for ECLS Animal Models-Introduction of the "RatOx" Oxygenator and Preliminary In Vitro Results. MICROMACHINES 2023; 14:800. [PMID: 37421033 DOI: 10.3390/mi14040800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 07/09/2023]
Abstract
The overall survival rate of extracorporeal life support (ECLS) remains at 60%. Research and development has been slow, in part due to the lack of sophisticated experimental models. This publication introduces a dedicated rodent oxygenator ("RatOx") and presents preliminary in vitro classification tests. The RatOx has an adaptable fiber module size for various rodent models. Gas transfer performances over the fiber module for different blood flows and fiber module sizes were tested according to DIN EN ISO 7199. At the maximum possible amount of effective fiber surface area and a blood flow of 100 mL/min, the oxygenator performance was tested to a maximum of 6.27 mL O2/min and 8.2 mL CO2/min, respectively. The priming volume for the largest fiber module is 5.4 mL, while the smallest possible configuration with a single fiber mat layer has a priming volume of 1.1 mL. The novel RatOx ECLS system has been evaluated in vitro and has demonstrated a high degree of compliance with all pre-defined functional criteria for rodent-sized animal models. We intend for the RatOx to become a standard testing platform for scientific studies on ECLS therapy and technology.
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Affiliation(s)
- Lasse J Strudthoff
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Jannis Focke
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Felix Hesselmann
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Andreas Kaesler
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Ana Martins Costa
- Department of Biomechanical Engineering, Faculty of Engineering Technologies, University of Twente, 7522 LW Enschede, The Netherlands
| | - Peter C Schlanstein
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Thomas Schmitz-Rode
- Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Ulrich Steinseifer
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Niklas B Steuer
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Bettina Wiegmann
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hanover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), 30625 Hanover, Germany
- German Center for Lung Research (DLZ), 30625 Hanover, Germany
| | - Jutta Arens
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
- Department of Biomechanical Engineering, Faculty of Engineering Technologies, University of Twente, 7522 LW Enschede, The Netherlands
| | - Sebastian V Jansen
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
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4
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Li Y, Huang J, Zhang R, Wang S, Cheng X, Zhang P, Zhai K, Wang W, Liu D, Gao B. Establishment of a venovenous extracorporeal membrane oxygenation in a rat model of acute respiratory distress syndrome. Perfusion 2023; 38:85-91. [PMID: 34378461 DOI: 10.1177/02676591211031468] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Venovenous extracorporeal membrane oxygenation (VV ECMO) is now considered a reasonable option to salvage acute respiratory distress syndrome (ARDS). However, we lack a rodent model for experimental studies. This study was undertaken to establish an animal model of VV ECMO in ARDS rats. METHODS A total of 18 Sprague-Dawley (SD) rats (350 ± 50 g) were used in this study. Using a rat model of oleic acid (OA)-induced ARDS, VV ECMO was established through cavoatrial cannulation of the right jugular vein for venous drainage and venous reinfusion with a specially designed three-cavity catheter. Continuous arterial pressure monitoring was implemented by using a catheter through cannulation of the right femoral artery. The central temperature was monitored with a rectal probe. Arterial blood gas monitoring was implemented by a blood gas analyzer at three-time points: at baseline, 1-hour (after OA modeling), and 3.5-hour (after VV ECMO support). Lung tissue and bronchoalveolar lavage fluid were harvested respectively for protein concentration and pulmonary histologic evaluation to confirm the alleviation of lung injury during VV ECMO. RESULTS Following ARDS induced by OA, ten rats were successfully established on VV ECMO without failure and survived the ECMO procedure. VV ECMO alleviated lung injury and restored adequate circulation for the return of lung function and oxygenation. VV ECMO was associated with decreased lung injury score, wet/dry weight ratio, and fluid leakage into airspaces. CONCLUSION We have established a reliable, economical, and functioning ARDS rat model of VV ECMO.
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Affiliation(s)
- Yongnan Li
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.,Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Jian Huang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.,Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Rongzhi Zhang
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Shixiong Wang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Xingdong Cheng
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.,Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Pengbin Zhang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.,Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Kerong Zhai
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.,Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Wei Wang
- Department of Cardiopulmonary Bypass, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Debin Liu
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Bingren Gao
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.,Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
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5
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Lescroart M, Pressiat C, Péquignot B, Tran N, Hébert JL, Alsagheer N, Gambier N, Ghaleh B, Scala-Bertola J, Levy B. Impaired Pharmacokinetics of Amiodarone under Veno-Venous Extracorporeal Membrane Oxygenation: From Bench to Bedside. Pharmaceutics 2022; 14:pharmaceutics14050974. [PMID: 35631560 PMCID: PMC9147299 DOI: 10.3390/pharmaceutics14050974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Adjusting drug therapy under veno-venous extracorporeal membrane oxygenation (VV ECMO) is challenging. Although impaired pharmacokinetics (PK) under VV ECMO have been reported for sedative drugs and antibiotics, data about amiodarone are lacking. We evaluated the pharmacokinetics of amiodarone under VV ECMO both in vitro and in vivo. Methods: In vitro: Amiodarone concentration decays were compared between closed-loop ECMO and control stirring containers over a 24 h period. In vivo: Potassium-induced cardiac arrest in 10 pigs with ARDS, assigned to either control or VV ECMO groups, was treated with 300 mg amiodarone injection under continuous cardiopulmonary resuscitation. Pharmacokinetic parameters Cmax, Tmax AUC and F were determined from both direct amiodarone plasma concentrations observation and non-linear mixed effects modeling estimation. Results: An in vitro study revealed a rapid and significant decrease in amiodarone concentrations in the closed-loop ECMO circuitry whereas it remained stable in control experiment. In vivo study revealed a 32% decrease in the AUC and a significant 42% drop of Cmax in the VV ECMO group as compared to controls. No difference in Tmax was observed. VV ECMO significantly modified both central distribution volume and amiodarone clearance. Monte Carlo simulations predicted that a 600 mg bolus of amiodarone under VV ECMO would achieve the amiodarone bioavailability observed in the control group. Conclusions: This is the first study to report decreased amiodarone bioavailability under VV ECMO. Higher doses of amiodarone should be considered for effective amiodarone exposure under VV ECMO.
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Affiliation(s)
- Mickaël Lescroart
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital Brabois, 54000 Nancy, France; (B.P.); (B.L.)
- Groupe Choc, Équipe 2, INSERM U 1116, Faculté de Médecine, 54000 Nancy, France
- Faculté de Médecine, Université de Lorraine, 54000 Nancy, France;
- Correspondence: ; Tel.: +33-142-165-608; Fax: +33-142-165-576
| | - Claire Pressiat
- Laboratoire de Pharmacologie, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Université Paris Est-Créteil, 94000 Créteil, France;
- Team 3, INSERM U955, Université Paris Est Créteil, Université Paris-Est, 94010 Créteil, France
- UMR S955, DHU A-TVB, Université Paris-Est Créteil (UPEC), Université Paris-Est, 94000 Créteil, France
| | - Benjamin Péquignot
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital Brabois, 54000 Nancy, France; (B.P.); (B.L.)
- Groupe Choc, Équipe 2, INSERM U 1116, Faculté de Médecine, 54000 Nancy, France
- Faculté de Médecine, Université de Lorraine, 54000 Nancy, France;
| | - N’Guyen Tran
- Faculté de Médecine, Université de Lorraine, 54000 Nancy, France;
- École de Chirurgie, Faculté de Médecine, Université de Lorraine, 54000 Nancy, France
| | - Jean-Louis Hébert
- Institut de Cardiologie, Hôpital Pitié-Salpêtrière, CHU Pitié-Salpêtrière, AP-HP, Université de la Sorbonne, Boulevard de L’Hôpital, 75013 Paris, France;
| | - Nassib Alsagheer
- Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Pharmacologie Clinique et Toxicologie, Université de Lorraine, 54000 Nancy, France; (N.A.); (N.G.); (J.S.-B.)
| | - Nicolas Gambier
- Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Pharmacologie Clinique et Toxicologie, Université de Lorraine, 54000 Nancy, France; (N.A.); (N.G.); (J.S.-B.)
- CNRS, IMoPA, Université de Lorraine, 54000 Nancy, France
| | - Bijan Ghaleh
- U955-IMRB, Inserm, Université Paris-Est Créteil (UPEC), École Nationale Vétérinaire d’Alfort, Maisons-Alfort, 94000 Créteil, France;
| | - Julien Scala-Bertola
- Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Pharmacologie Clinique et Toxicologie, Université de Lorraine, 54000 Nancy, France; (N.A.); (N.G.); (J.S.-B.)
- CNRS, IMoPA, Université de Lorraine, 54000 Nancy, France
| | - Bruno Levy
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital Brabois, 54000 Nancy, France; (B.P.); (B.L.)
- Groupe Choc, Équipe 2, INSERM U 1116, Faculté de Médecine, 54000 Nancy, France
- Faculté de Médecine, Université de Lorraine, 54000 Nancy, France;
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6
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Caspari S, Schwärzel LS, Jungmann AM, Schmoll N, Seiler F, Muellenbach RM, Krawczyk M, Dinh QT, Bals R, Lepper PM, Omlor AJ. A Novel Mock Circuit to Test Full-Flow Extracorporeal Membrane Oxygenation. MEMBRANES 2022; 12:membranes12050493. [PMID: 35629818 PMCID: PMC9147719 DOI: 10.3390/membranes12050493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) has become an important therapeutic approach in the COVID-19 pandemic. The development and research in this field strongly relies on animal models; however, efforts are being made to find alternatives. In this work, we present a new mock circuit for ECMO that allows measurements of the oxygen transfer rate of a membrane lung at full ECMO blood flow. The mock utilizes a large reservoir of heparinized porcine blood to measure the oxygen transfer rate of the membrane lung in a single passage. The oxygen transfer rate is calculated from blood flow, hemoglobin value, venous saturation, and post-membrane arterial oxygen pressure. Before the next measuring sequence, the blood is regenerated to a venous condition with a sweep gas of nitrogen and carbon dioxide. The presented mock was applied to investigate the effect of a recirculation loop on the oxygen transfer rate of an ECMO setup. The recirculation loop caused a significant increase in post-membrane arterial oxygen pressure (paO2). The effect was strongest for the highest recirculation flow. This was attributed to a smaller boundary layer on gas fibers due to the increased blood velocity. However, the increase in paO2 did not translate to significant increases in the oxygen transfer rate because of the minor significance of physically dissolved oxygen for gas transfer. In conclusion, our results regarding a new ECMO mock setup demonstrate that recirculation loops can improve ECMO performance, but not enough to be clinically relevant.
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Affiliation(s)
- Stefan Caspari
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
| | - Leonie S. Schwärzel
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
| | - Anna M. Jungmann
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
| | - Nicole Schmoll
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
| | - Frederik Seiler
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
| | - Ralf M. Muellenbach
- Department of Anaesthesiology and Critical Care, Campus Kassel of the University of Southampton, 34125 Kassel, Germany;
| | - Marcin Krawczyk
- Department of Internal Medicine II, University Hospital of Saarland, 66424 Homburg, Germany;
- Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Centre for Preclinical Research, Medical University of Warsaw, 02091 Warsaw, Poland
| | - Quoc Thai Dinh
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
| | - Robert Bals
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
| | - Philipp M. Lepper
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
- Correspondence:
| | - Albert J. Omlor
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
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7
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Zarragoikoetxea I, Pajares A, Moreno I, Porta J, Koller T, Cegarra V, Gonzalez A, Eiras M, Sandoval E, Sarralde J, Quintana-Villamandos B, Vicente Guillén R. Documento de consenso SEDAR/SECCE sobre el manejo de ECMO. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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8
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Gao S, Wang W, Qi J, Liu G, Wang J, Yan S, Teng Y, Zhou C, Wang Q, Yan W, Zhang Q, Liu Y, Gao B, Ji B. Safety and Efficacy of a Novel Centrifugal Pump and Driving Devices of the OASSIST ECMO System: A Preclinical Evaluation in the Ovine Model. Front Med (Lausanne) 2021; 8:712205. [PMID: 34708051 PMCID: PMC8542924 DOI: 10.3389/fmed.2021.712205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) provides cardiopulmonary support for critically ill patients. Portable ECMO devices can be applied in both in-hospital and out-of-hospital emergency conditions. We evaluated the safety and biocompatibility of a novel centrifugal pump and ECMO device of the OASSIST ECMO System (Jiangsu STMed Technologies Co., Suzhou, China) in a 168-h ovine ECMO model. Methods: The portable OASSIST ECMO system consists of the control console, the pump drive, and the disposable centrifugal pump. Ten healthy sheep were used to evaluate the OASSIST ECMO system. Five were supported on veno-venous ECMO and five on veno-arterial ECMO, each for 168 h. The systemic anticoagulation was achieved by continuous heparin infusion to maintain the activated clotting time (ACT) between 220 and 250 s. The rotary speed was set at 3,200–3,500 rpm. The ECMO configurations and ACT were recorded every 6 hours (h). The free hemoglobin (fHb), complete blood count, and coagulation action test were monitored, at the 6th h and every 24 h after the initiation of the ECMO. The dissection of the pump head and oxygenator were conducted to explore thrombosis. Results: Ten sheep successfully completed the study duration without device-related accidents. The pumps ran stably, and the ECMO flow ranged from 1.6 ± 0.1 to 2.0 ± 0.11 L/min in the V-V group, and from 1.8 ± 0.1 to 2.4 ± 0.14 L/min in the V-A group. The anticoagulation was well-performed. The ACT was maintained at 239.78 ± 36.31 s, no major bleeding or thrombosis was observed during the ECMO run or in the autopsy. 3/5 in the V-A group and 4/5 in the V-V group developed small thrombus in the bearing pedestal. No obvious thrombus formed in the oxygenator was observed. The hemolytic blood damage was not significant. The average fHb was 0.17 ± 0.12 g/L. Considering hemodilution, the hemoglobin, white blood cell, and platelets didn't reduce during the ECMO runs. Conclusions: The OASSIST ECMO system shows satisfactory safety and biocompatibility for the 168-h preclinical evaluation in the ovine model. The OASSIST ECMO system is promising to be applied in clinical conditions in the future.
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Affiliation(s)
- Sizhe Gao
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Weining Wang
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China.,Jiangsu STMed Technology Co. Ltd., Suzhou, China
| | - Jiachen Qi
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Gang Liu
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jian Wang
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shujie Yan
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yuan Teng
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Chun Zhou
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qian Wang
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Weidong Yan
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qiaoni Zhang
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Youjun Liu
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Bin Gao
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Bingyang Ji
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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9
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Zarragoikoetxea I, Pajares A, Moreno I, Porta J, Koller T, Cegarra V, Gonzalez AI, Eiras M, Sandoval E, Aurelio Sarralde J, Quintana-Villamandos B, Vicente Guillén R. SEDAR/SECCE ECMO management consensus document. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:443-471. [PMID: 34535426 DOI: 10.1016/j.redare.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 12/14/2020] [Indexed: 06/13/2023]
Abstract
ECMO is an extracorporeal cardiorespiratory support system whose use has been increased in the last decade. Respiratory failure, postcardiotomy shock, and lung or heart primary graft failure may require the use of cardiorespiratory mechanical assistance. In this scenario perioperative medical and surgical management is crucial. Despite the evolution of technology in the area of extracorporeal support, morbidity and mortality of these patients continues to be high, and therefore the indication as well as the ECMO removal should be established within a multidisciplinary team with expertise in the area. This consensus document aims to unify medical knowledge and provides recommendations based on both the recent bibliography and the main national ECMO implantation centres experience with the goal of improving comprehensive patient care.
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Affiliation(s)
- I Zarragoikoetxea
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | - A Pajares
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - I Moreno
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J Porta
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - T Koller
- Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - V Cegarra
- Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A I Gonzalez
- Servicio de Anestesiología y Reanimación, Hospital Puerta de Hierro, Madrid, Spain
| | - M Eiras
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Santiago, La Coruña, Spain
| | - E Sandoval
- Servicio de Cirugía Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Aurelio Sarralde
- Servicio de Cirugía Cardiovascular, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - B Quintana-Villamandos
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R Vicente Guillén
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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10
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Cho HJ, Kayumov M, Kim D, Lee K, Onyekachi FO, Jeung KW, Kim Y, Suen JY, Fraser JF, Jeong IS. Acute Immune Response in Venoarterial and Venovenous Extracorporeal Membrane Oxygenation Models of Rats. ASAIO J 2021; 67:546-553. [PMID: 32826395 DOI: 10.1097/mat.0000000000001265] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Although experimental extracorporeal membrane oxygenation (ECMO) animal models have been reported, there are few studies on the immune response to ECMO. We developed the venoarterial (VA) and venovenous (VV) model in rats and serially investigated the changes in the distribution of immune cells. Forty rats underwent both VA and VV modes of ECMO, and blood samples were collected at 1 day before ECMO (D-1), at the end of ECMO run (D+0), and 3 days after the ECMO (D+3). Flow cytometry was used to characterize surface marker expression (CD3, CD4, CD8, CD43, CD45, CD45R, CD161, and His48) on immune cells. Granulocytes were initially activated in both ECMO types and were further reduced but not normalized until 3 days of decannulation. Monocyte and natural killer cells were decreased initially in VA mode. B lymphocytes, helper T lymphocytes, and cytotoxic T lymphocytes also significantly decreased in VA modes after ECMO, but this phenomenon was not prominent in the VV modes. Overall immune cells proportion changed after ECMO run in both modes, and the immunologic balance altered significantly in the VA than in VV mode. Our ECMO model is feasible for the hemodynamic and immunologic research, and further long-term evaluation is needed.
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Affiliation(s)
- Hwa-Jin Cho
- From the Department of Pediatrics, Chonnam National University Children's Hospital and Medical School, Gwangju, Republic of Korea
- Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia
- Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
| | - Mukhammad Kayumov
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Dowan Kim
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Kyoseon Lee
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Francis Obiweluozor Onyekachi
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Kyung-Woon Jeung
- Department of Emergency Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Yongsook Kim
- Biomedical Research Institute, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia
- Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia
- Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
| | - In-Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
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11
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Low Spontaneous Breathing Effort during Extracorporeal Membrane Oxygenation in a Porcine Model of Severe Acute Respiratory Distress Syndrome. Anesthesiology 2020; 133:1106-1117. [PMID: 32898217 DOI: 10.1097/aln.0000000000003538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND A lung rest strategy is recommended during extracorporeal membrane oxygenation in severe acute respiratory distress syndrome (ARDS). However, spontaneous breathing modes are frequently used in this context. The impact of this approach may depend on the intensity of breathing efforts. The authors aimed to determine whether a low spontaneous breathing effort strategy increases lung injury, compared to a controlled near-apneic ventilation, in a porcine severe ARDS model assisted by extracorporeal membrane oxygenation. METHODS Twelve female pigs were subjected to lung injury by repeated lavages, followed by 2-h injurious ventilation. Thereafter, animals were connected to venovenous extracorporeal membrane oxygenation and during the first 3 h, ventilated with near-apneic ventilation (positive end-expiratory pressure, 10 cm H2O; driving pressure, 10 cm H2O; respiratory rate, 5/min). Then, animals were allocated into (1) near-apneic ventilation, which continued with the previous ventilatory settings; and (2) spontaneous breathing: neuromuscular blockers were stopped, sweep gas flow was decreased until regaining spontaneous efforts, and ventilation was switched to pressure support mode (pressure support, 10 cm H2O; positive end-expiratory pressure, 10 cm H2O). In both groups, sweep gas flow was adjusted to keep Paco2 between 30 and 50 mmHg. Respiratory and hemodynamic as well as electric impedance tomography data were collected. After 24 h, animals were euthanized and lungs extracted for histologic tissue analysis. RESULTS Compared to near-apneic group, the spontaneous breathing group exhibited a higher respiratory rate (52 ± 17 vs. 5 ± 0 breaths/min; mean difference, 47; 95% CI, 34 to 59; P < 0.001), but similar tidal volume (2.3 ± 0.8 vs. 2.8 ± 0.4 ml/kg; mean difference, 0.6; 95% CI, -0.4 to 1.4; P = 0.983). Extracorporeal membrane oxygenation settings and gas exchange were similar between groups. Dorsal ventilation was higher in the spontaneous breathing group. No differences were observed regarding histologic lung injury. CONCLUSIONS In an animal model of severe ARDS supported with extracorporeal membrane oxygenation, spontaneous breathing characterized by low-intensity efforts, high respiratory rates, and very low tidal volumes did not result in increased lung injury compared to controlled near-apneic ventilation. EDITOR’S PERSPECTIVE
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12
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Millar JE, Bartnikowski N, Passmore MR, Obonyo NG, Malfertheiner MV, von Bahr V, Redd MA, See Hoe L, Ki KK, Pedersen S, Boyle AJ, Baillie JK, Shekar K, Palpant N, Suen JY, Matthay MA, McAuley DF, Fraser JF. Combined Mesenchymal Stromal Cell Therapy and Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome. A Randomized Controlled Trial in Sheep. Am J Respir Crit Care Med 2020; 202:383-392. [PMID: 32293914 DOI: 10.1164/rccm.201911-2143oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Rationale: Mesenchymal stromal cell (MSC) therapy is a promising intervention for acute respiratory distress syndrome (ARDS), although trials to date have not investigated its use alongside extracorporeal membrane oxygenation (ECMO). Recent preclinical studies have suggested that combining these interventions may attenuate the efficacy of ECMO.Objectives: To determine the safety and efficacy of MSC therapy in a model of ARDS and ECMO.Methods: ARDS was induced in 14 sheep, after which they were established on venovenous ECMO. Subsequently, they received either endobronchial induced pluripotent stem cell-derived human MSCs (hMSCs) (n = 7) or cell-free carrier vehicle (vehicle control; n = 7). During ECMO, a low Vt ventilation strategy was employed in addition to protocolized hemodynamic support. Animals were monitored and supported for 24 hours. Lung tissue, bronchoalveolar fluid, and plasma were analyzed, in addition to continuous respiratory and hemodynamic monitoring.Measurements and Main Results: The administration of hMSCs did not improve oxygenation (PaO2/FiO2 mean difference = -146 mm Hg; P = 0.076) or pulmonary function. However, histological evidence of lung injury (lung injury score mean difference = -0.07; P = 0.04) and BAL IL-8 were reduced. In addition, hMSC-treated animals had a significantly lower cumulative requirement for vasopressor. Despite endobronchial administration, animals treated with hMSCs had a significant elevation in transmembrane oxygenator pressure gradients. This was accompanied by more pulmonary artery thromboses and adherent hMSCs found on explanted oxygenator fibers.Conclusions: Endobronchial hMSC therapy in an ovine model of ARDS and ECMO can impair membrane oxygenator function and does not improve oxygenation. These data do not recommend the safe use of hMSCs during venovenous ECMO.
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Affiliation(s)
- Jonathan E Millar
- Critical Care Research Group, the Prince Charles Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine and.,Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Nicole Bartnikowski
- Critical Care Research Group, the Prince Charles Hospital, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Margaret R Passmore
- Critical Care Research Group, the Prince Charles Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine and
| | - Nchafatso G Obonyo
- Critical Care Research Group, the Prince Charles Hospital, Brisbane, Queensland, Australia.,Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom
| | - Maximillian V Malfertheiner
- Critical Care Research Group, the Prince Charles Hospital, Brisbane, Queensland, Australia.,Department of Internal Medicine II, Cardiology and Pneumology, University Medical Center Regensburg, Regensburg, Germany
| | - Viktor von Bahr
- Critical Care Research Group, the Prince Charles Hospital, Brisbane, Queensland, Australia.,Section for Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Meredith A Redd
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
| | - Louise See Hoe
- Critical Care Research Group, the Prince Charles Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine and
| | - Katrina K Ki
- Critical Care Research Group, the Prince Charles Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine and
| | - Sanne Pedersen
- Critical Care Research Group, the Prince Charles Hospital, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Andrew J Boyle
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - J Kenneth Baillie
- Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom; and
| | - Kiran Shekar
- Critical Care Research Group, the Prince Charles Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine and
| | - Nathan Palpant
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
| | - Jacky Y Suen
- Critical Care Research Group, the Prince Charles Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine and
| | - Michael A Matthay
- Department of Medicine and.,Department of Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California
| | - Daniel F McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - John F Fraser
- Critical Care Research Group, the Prince Charles Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine and
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13
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Amata M, Martucci G, Granata A, Tuzzolino F, Panarello G, Bianco C, Lorusso R, Traina M, Arcadipane A. The role of endoscopy as non-invasive procedure to manage gastrointestinal complications during extracorporeal membrane oxygenation. Perfusion 2020; 35:786-794. [PMID: 32156186 DOI: 10.1177/0267659120909669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Gastrointestinal bleeding is a life-threatening complication in patients undergoing extracorporeal membrane oxygenation support. Despite data on increased mortality due to gastrointestinal bleeding, there is little data on the treatment of such conditions under extracorporeal membrane oxygenation, and on the possibilities of advanced endoscopic therapy to non-invasively solve these bleeding complications. No clear treatment in the case of extracorporeal membrane oxygenation support is recommended in the guidelines. METHODS Retrospective observational cohort study including 134 veno-venous extracorporeal membrane oxygenation patients for acute respiratory failure from 2009 to 2018 at IRCCS-ISMETT (Italy). Patients were divided into two groups according to gastrointestinal bleeding episodes and reviewed for type of endoscopic therapy. Gastrointestinal bleeding group was characterized for pre-extracorporeal membrane oxygenation characteristics, management variables-including amount of transfusions and clinical outcomes. RESULTS Fourteen (14) patients (10.4%) experienced upper (n = 13) or lower (n = 1) gastrointestinal bleeding. Gastrointestinal bleeding and no-gastrointestinal bleeding group had similar characteristics apart from higher creatinine in the gastrointestinal bleeding group (1.9 mg/dL (1.3-4.9) vs 1.2 mg/dL (0.7-1.8), p = 0.03). In 3 of the 14 patients (21%), endoscopy showed no signs of active bleeding (nasogastric or feeding tube decubitus), and no specific intervention was performed. Active bleeding was recognized in 11 of the 14 patients (79 %). No patients died of fatal bleeding in the gastrointestinal bleeding group. Endoscopic therapy was feasible, with a complete bleeding control in all the cases: five Hemospray®, two fibrin glue, two metallic clips, one combined approach metallic clips with epinephrine, and one cyanoacrylate. The extracorporeal membrane oxygenation course was significantly longer in the gastrointestinal bleeding group: 19.5 (15-36) days vs 13.5 (8-25) days, p = 0.01. No significant differences in mortality were found between the two groups (all p values > 0.05). CONCLUSION Advanced endoscopic therapy during veno-venous extracorporeal membrane oxygenation may contribute to reducing the negative effects on mortality for gastrointestinal bleeding episodes.
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Affiliation(s)
- Michele Amata
- Endoscopy Service, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Antonino Granata
- Endoscopy Service, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Fabio Tuzzolino
- Research Department, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Giovanna Panarello
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | | | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Mario Traina
- Endoscopy Service, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Antonio Arcadipane
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
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14
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Zhang FZ, Qin L, Yuan JX, Tang LF. Plastic bronchitis due to adenoviral infection: a case report. BMC Pediatr 2020; 20:61. [PMID: 32039717 PMCID: PMC7008568 DOI: 10.1186/s12887-020-1954-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 02/03/2020] [Indexed: 12/12/2022] Open
Abstract
Background Plastic bronchitis (PB) frequently occurs as a serious postoperative complication of the Fontan procedure. The definitive causes of PB are unknown. Case presentation Herein, we report a pediatric case of PB secondary to adenoviral infection. A 4-year-old girl was admitted to the general pediatric ward for cough since 2 weeks and fever since 11 days. Consolidated lesions were noted in the right upper and both lower lung lobes. Extracorporeal membrane oxygenation was performed because the patient’s respiratory failure remained unalleviated despite the use of a ventilator. Bronchial dendritic casts were extracted using flexible bronchoscopy, and the patient’s breathing improved. Pathological examination of the dendritic cast confirmed the diagnosis of type I PB. The exfoliated cells of sputum and cells from bronchoalveolar lavage fluid were positive for adenoviral antigen. Human adenovirus 7 was detected by next-generation sequencing of the bronchoalveolar lavage fluid. The patient recovered and was discharged 39 days after admission without recurrence of cough or wheezing. Conclusions PB due to human adenovirus 7 infection should be considered in children with persistent respiratory failure. Flexible bronchoscopy should be performed early to confirm diagnosis and to remove any airway obstruction.
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Affiliation(s)
- Fei Zhou Zhang
- Zhejiang University School of Medicine of Children's Hospital, 3333 Binsheng Road, Hangzhou, 310051, China
| | - Lu Qin
- Zhejiang University School of Medicine of Children's Hospital, 3333 Binsheng Road, Hangzhou, 310051, China
| | - Jie Xin Yuan
- Zhejiang University School of Medicine of Children's Hospital, 3333 Binsheng Road, Hangzhou, 310051, China
| | - Lan Fang Tang
- Zhejiang University School of Medicine of Children's Hospital, 3333 Binsheng Road, Hangzhou, 310051, China.
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15
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Kishaba T. Acute or subacute progressive interstitial pneumonia. Respir Investig 2019; 57:405-407. [PMID: 31248831 DOI: 10.1016/j.resinv.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/11/2019] [Accepted: 05/20/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Tomoo Kishaba
- Department of Respiratory Medicine, Okinawa Chubu Hospital, Miyazato 281, Uruma City, Okinawa, Japan.
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