Department of Cardiothoracic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark.
Scand J Trauma Resusc Emerg Med. 2018 Nov 22;26(1):103. doi: 10.1186/s13049-018-0570-6.
Severe intoxication with carbon monoxide (CO) is extremely lethal and causes numerous deaths due to cardiac or respiratory failure. Conventional intensive treatment may not be sufficient. The aim of this study was to investigate the treatment effect of extracorporeal veno-arterial extracorporeal membrane oxygenation (ECMO) following severe CO poisoning in an experimental porcine model.
A total of twelve pigs were anaesthetized, routinely monitored and intoxicated by inhalation of CO until the beginning of cardiac failure and randomized to a treatment (ventilator using an FiO of 100% or ECMO). In the case of cardiac arrest, advanced resuscitation using standard guidelines was performed for at least 10 min. ECMO was also initiated in the ventilation group if the return of spontaneous circulation did not occur within 10 min. Lung tissue biopsies were obtained before and after CO intoxication.
All animals in the ECMO group survived; however, one had to be resuscitated due to cardiac arrest. A single animal survived in the ventilator group, but five animals suffered from cardiac arrest at an average of 11.8 min after initiation of treatment. Conventional resuscitation failed in these animals, but four animals were successfully resuscitated after the establishment of ECMO. A significant decrease was noticed in PO with increasing HbCO, but there was no increase in pulmonary vascular resistance. No differences in H&E-stained lung tissue biopsies were observed.
The use of ECMO following severe CO poisoning greatly improved survival compared with conventional resuscitation in an experimental porcine model. This study forms the basis for further research among patients.
严重一氧化碳（CO）中毒极具致命性，可导致心脏或呼吸衰竭而引发众多死亡。常规强化治疗可能并不足够。本研究旨在探讨体外动静脉体外膜肺氧合（ECMO）在严重 CO 中毒实验猪模型中的治疗效果。
共 12 头猪接受麻醉、常规监测，并通过吸入 CO 中毒，直至出现心力衰竭，然后随机分为治疗组（使用 100%FiO2 的呼吸机或 ECMO）。如果心脏停搏，使用标准指南进行高级复苏，至少 10 分钟。如果在 10 分钟内未恢复自主循环，也在通气组中启动 ECMO。在 CO 中毒前后获取肺组织活检。
ECMO 组的所有动物均存活，但有一只因心脏骤停而需要复苏。通气组中有一只动物存活，但五只动物在治疗开始后平均 11.8 分钟出现心脏骤停。这些动物的常规复苏失败，但在建立 ECMO 后有四只动物成功复苏。随着 HbCO 的增加，PO 显著下降，但肺血管阻力没有增加。H&E 染色的肺组织活检未见差异。
与常规复苏相比，在严重 CO 中毒后使用 ECMO 可显著提高实验猪模型的存活率。本研究为患者进一步研究奠定了基础。
