Itoh Hideshi, Ichiba Shingo, Ujike Yoshihito, Douguchi Takuma, Obata Hideaki, Inamori Syuji, Iwasaki Tatsuo, Kasahara Shingo, Sano Shunji, Ündar Akif
Department of Medical Engineering, Faculty of Health Sciences, Junshin Gakuen University, Fukuoka, Japan.
Departments of, Emergency and Critical Care Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Artif Organs. 2016 Jan;40(1):19-26. doi: 10.1111/aor.12588. Epub 2015 Nov 3.
The objective of this study was to compare the effects of pulsatile and nonpulsatile extracorporeal membrane oxygenation (ECMO) on hemodynamic energy and systemic microcirculation in an acute cardiac failure model in piglets. Fourteen piglets with a mean body weight of 6.08 ± 0.86 kg were divided into pulsatile (N = 7) and nonpulsatile (N = 7) ECMO groups. The experimental ECMO circuit consisted of a centrifugal pump, a membrane oxygenator, and a pneumatic pulsatile flow generator system developed in-house. Nonpulsatile ECMO was initiated at a flow rate of 140 mL/kg/min for the first 30 min with normal heart beating, with rectal temperature maintained at 36°C. Ventricular fibrillation was then induced with a 3.5-V alternating current to generate a cardiac dysfunction model. Using this model, we collected the data on pulsatile and nonpulsatile groups. The piglets were weaned off ECMO at the end of the experiment (180 min after ECMO was initiated). The animals did not receive blood transfusions, inotropic drugs, or vasoactive drugs. Blood samples were collected to measure hemoglobin, methemoglobin, blood gases, electrolytes, and lactic acid levels. Hemodynamic energy was calculated using the Shepard's energy equivalent pressure. Near-infrared spectroscopy was used to monitor brain and kidney perfusion. The pulsatile ECMO group had a higher atrial pressure (systolic and mean), and significantly higher regional saturation at the brain level, than the nonpulsatile group (for both, P < 0.05). Additionally, the pulsatile ECMO group had higher methemoglobin levels within the normal range than the nonpulsatile group. Our study demonstrated that pulsatile ECMO produces significantly higher hemodynamic energy and improves systemic microcirculation, compared with nonpulsatile ECMO in acute cardiac failure.
本研究的目的是比较搏动性和非搏动性体外膜肺氧合（ECMO）对仔猪急性心力衰竭模型中血流动力学能量和全身微循环的影响。14只平均体重为6.08±0.86千克的仔猪被分为搏动性（N = 7）和非搏动性（N = 7）ECMO组。实验性ECMO回路由一台离心泵、一个膜式氧合器和一个自行研发的气动搏动流发生器系统组成。非搏动性ECMO在最初30分钟以140毫升/千克/分钟的流速启动，此时心脏正常跳动，直肠温度维持在36°C。然后用3.5伏交流电诱发心室颤动以建立心脏功能障碍模型。利用该模型，我们收集了搏动性和非搏动性组的数据。实验结束时（ECMO启动后180分钟）仔猪撤离ECMO。动物未接受输血、强心药物或血管活性药物。采集血样以测量血红蛋白、高铁血红蛋白、血气、电解质和乳酸水平。使用谢泼德能量等效压力计算血流动力学能量。采用近红外光谱法监测脑和肾灌注。搏动性ECMO组的心房压力（收缩压和平均压）较高，且脑水平的区域饱和度显著高于非搏动性组（两者均P < 0.05）。此外，搏动性ECMO组的高铁血红蛋白水平在正常范围内高于非搏动性组。我们的研究表明，在急性心力衰竭中，与非搏动性ECMO相比，搏动性ECMO产生的血流动力学能量显著更高，并改善了全身微循环。
