2nd Department of Medicine, Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
Pulm Pharmacol Ther. 2013 Dec;26(6):655-60. doi: 10.1016/j.pupt.2013.03.008. Epub 2013 Mar 21.
ECMO (extracorporeal membrane oxygenation) is increasingly used in severe hemodynamic compromise and cardiac arrest (CA). Pulmonary infections are frequent in these patients. Venoarterial (VA) ECMO decreases pulmonary blood flow and antibiotic availability in lungs during VA ECMO treated CA is not known. We aimed to assess early vancomycin, amikacin and gentamicin concentrations in the pulmonary artery as well as tracheal aspirate and to determine penetration ratios of these antibiotics to lung tissue in a pig model of VA ECMO treated CA.
Twelve female pigs, body weight 51.5 ± 3.5 kg, were subjected to prolonged CA managed by different modes of VA ECMO. Anesthetized animals underwent 15 min of ventricular fibrillation (VF) followed by continued VF with ECMO flow of 100 mL/kg/min. Immediately after institution of ECMO, a 30 min vancomycin infusion (10 mg/kg) was started and amikacin and gentamicin boluses (7.5 and 3 mg/kg, respectively) were administered. ECMO circuit, aortic, pulmonary arterial, and tracheal aspirate concentrations of antibiotics were measured at 30 and 60 min after administration; penetration ratios were calculated.
All 30 min antibiotic concentrations and 60 min concentration for gentamicin in the pulmonary artery were no different than the aorta. However, the 60 min pulmonary artery vancomycin and amikacin values were significantly higher than aortic, 19.8 (14.3-21.6) vs. 17.6 (14.2-19.0) mg/L, p = 0.009, and 15.6 mg/L (11.0-18.6) vs. 11.2 (10.4-17.2) mg/L, p = 0.036, respectively. One hour penetration ratios were 18.5% for vancomycin, 34.9% for gentamicin and 38.8% for amikacin.
In a pig model of VA ECMO treated prolonged CA, despite diminished pulmonary flow, VA ECMO does not decrease early vancomycin, gentamicin, and amikacin concentrations in pulmonary artery. Within 1 h post administration, antibiotics can be detected in tracheal aspirate in adequate concentrations.
体外膜肺氧合（ECMO）越来越多地用于严重的血流动力学障碍和心脏骤停（CA）。这些患者肺部感染频繁。在接受 VA ECMO 治疗的 CA 期间，VA ECMO 会降低肺血流量和肺部抗生素的可用性，但目前尚不清楚这一点。我们的目的是评估在 VA ECMO 治疗的 CA 猪模型中，肺动脉、气管吸出物中早期万古霉素、阿米卡星和庆大霉素的浓度，并确定这些抗生素对肺组织的穿透比。
12 头雌性猪，体重 51.5±3.5kg，接受不同模式的 VA ECMO 治疗的延长 CA。麻醉动物经历 15 分钟的心室颤动（VF），然后继续进行 ECMO 流量为 100mL/kg/min 的 VF。在开始 ECMO 后立即开始 30 分钟的万古霉素输注（10mg/kg），并给予阿米卡星和庆大霉素（分别为 7.5 和 3mg/kg）。在给药后 30 和 60 分钟测量 ECMO 回路、主动脉、肺动脉和气管吸出物中的抗生素浓度；计算穿透比。
所有 30 分钟的抗生素浓度和 60 分钟的肺动脉庆大霉素浓度均与主动脉无差异。然而，肺动脉万古霉素和阿米卡星的 60 分钟值明显高于主动脉，分别为 19.8（14.3-21.6）比 17.6（14.2-19.0）mg/L，p=0.009 和 15.6mg/L（11.0-18.6）比 11.2（10.4-17.2）mg/L，p=0.036。万古霉素的 1 小时穿透比为 18.5%，庆大霉素为 34.9%，阿米卡星为 38.8%。
在接受 VA ECMO 治疗的延长 CA 的猪模型中，尽管肺血流量减少，但 VA ECMO 并未降低肺动脉中早期万古霉素、庆大霉素和阿米卡星的浓度。在给药后 1 小时内，气管吸出物中可以检测到足够浓度的抗生素。
