Vanhuyse Fabrice, Ducrocq Nicolas, Louis Huguette, Kattani Narimane Al, Laurent Nicolas, Joineau-Groubatch Frédérique, Falanga Aude, Maureira Juan-Pablo, Kimmoun Antoine, Girerd Nicolas, Tran Nguyen, Levy Bruno
*Service de chirurgie cardiaque et transplantations, Pole Cardiovasculaire et Réanimation Médicale, Hôpital Brabois, Vandoeuvre les Nancy, France †Université de Lorraine, Nancy, France ‡INSERM, Groupe Choc, U1116, Faculté de Médecine, Vandoeuvre les Nancy, France §École de chirurgie Nancy-Lorraine, Faculté de Médecine, Vandoeuvre les Nancy, France ¶CHU Nancy, Service de Réanimation Médicale Brabois, Pole Cardiovasculaire et Réanimation Médicale, Hôpital Brabois, Vandoeuvre les Nancy, France ||INSERM, Centre d'Investigations Cliniques-9501 and CHU de Vandoeuvre Nancy, les Nancy, France.
Shock. 2017 Feb;47(2):236-241. doi: 10.1097/SHK.0000000000000712.
Cardiogenic shock (CS) patients treated with extracorporeal membrane oxygenation (ECMO) have severe cardiac failure, associated with ischemia-reperfusion. The use of moderate hypothermia during ischemia-reperfusion syndrome is supported by experimental data. We therefore studied the effects of moderate hypothermia on cardiac and vascular function in pig ischemic CS treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). CS was induced in 12 anesthetized pigs by coronary ligation. After 1 h of CS, VA-ECMO was initiated and pigs were randomized to normothermia (38°C) or moderate hypothermia (34°C) during 8 h. Intrinsic cardiac function was measured using a left ventricular conductance catheter. At the end of the experiment, tissues were harvested for Western blotting. ECMO associated with norepinephrine infusion and volume resuscitation increased mean arterial pressure, mixed venous oxygen saturation as well as carotid, renal, and coronary blood flow without any differences between normothermia and hypothermia. Hypothermia was associated with less fluid and less norepinephrine infusion, lower lactate level, and higher urinary output. Vascular reactivity was superior in hypothermia comparatively to normothermia as expressed using norepinephrine dose-response curves. Pressure development during isovolumic contraction, left ventricular ejection fraction, and prerecruitable stroke work index were higher in the hypothermia group. There were no differences between normothermia and hypothermia with regard to carotid and mesenteric protein expression for iNOs, eNOS, and phospho AKt/AKt measured at the end of the experimentation. The incidence of surgical bleeding and coagulation disorders was the same in both groups. In conclusion, moderate and rapid hypothermia improves hemodynamics and cardiac and vascular function in a pig model of ischemic CS treated with ECMO.
接受体外膜肺氧合（ECMO）治疗的心源性休克（CS）患者存在严重心力衰竭，并伴有缺血再灌注。缺血再灌注综合征期间使用中度低温得到了实验数据的支持。因此，我们研究了中度低温对接受静脉-动脉体外膜肺氧合（VA-ECMO）治疗的猪缺血性CS心脏和血管功能的影响。通过冠状动脉结扎在12只麻醉猪中诱导出CS。CS持续1小时后开始VA-ECMO，并将猪随机分为正常体温组（38°C）或在8小时内维持中度低温组（34°C）。使用左心室电导导管测量心脏固有功能。实验结束时，采集组织进行蛋白质印迹分析。ECMO联合去甲肾上腺素输注和容量复苏可提高平均动脉压、混合静脉血氧饱和度以及颈动脉、肾和冠状动脉血流量，正常体温组和低温组之间无差异。低温与较少的液体和去甲肾上腺素输注、较低的乳酸水平以及较高的尿量相关。使用去甲肾上腺素剂量反应曲线表示，低温组的血管反应性优于正常体温组。低温组等容收缩期压力上升、左心室射血分数和预可募集搏功指数更高。实验结束时，正常体温组和低温组在颈动脉和肠系膜中诱导型一氧化氮合酶（iNOs）、内皮型一氧化氮合酶（eNOS）和磷酸化Akt/Akt蛋白表达方面无差异。两组手术出血和凝血障碍的发生率相同。总之，在接受ECMO治疗的猪缺血性CS模型中，中度快速低温可改善血流动力学以及心脏和血管功能。
