Djordjevic Ilija, Maier-Trauth Johanna, Gerfer Stephen, Elskamp Mara, Muehlbauer Thomas, Maul Alexandra, Rademann Pia, Ivanov Borko, Krasivskyi Ihor, Sabashnikov Anton, Kuhn Elmar, Slottosch Ingo, Wahlers Thorsten, Liakopoulos Oliver, Deppe Antje Christin
Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany.
Division of Thoracic and Cardiovascular Surgery, HELIOS Klinikum Siegburg, 53721 Siegburg, Germany.
J Clin Med. 2023 Aug 16;12(16):5330. doi: 10.3390/jcm12165330.
(1) Background: Fluid resuscitation is a necessary part of therapeutic measures to maintain sufficient hemodynamics in extracorporeal membrane oxygenation (ECMO) circulation. In a post-hoc analysis, we aimed to investigate the impact of increased volume therapy in veno-arterial ECMO circulation on renal function and organ edema in a large animal model. (2) Methods: ECMO therapy was performed in 12 female pigs (Deutsche Landrasse × Pietrain) for 10 h with subsequent euthanasia. Applicable volume, in regard to the necessary maintenance of hemodynamics, was divided into moderate and extensive volume therapy (MVT/EVT) due to the double quantity of calculated physiologic urine output for the planned study period. Respiratory and hemodynamic data were measured continuously. Additionally, renal function and organ edema were assessed by blood and tissue samples. (3) Results: Four pigs received MVT, and eight pigs received EVT. After 10 h of ECMO circulation, no major differences were seen between the groups in regard to hemodynamic and respiratory data. The relative change in creatinine after 10 h of ECMO support was significantly higher in EVT (1.3 ± 0.3 MVT vs. 1.8 ± 0.5 EVT; = 0.033). No major differences were evident for lung, heart, liver, and kidney samples in regard to organ edema in comparison of EVT and MVT. Bowel tissue showed a higher percentage of edema in EVT compared to MVT (77 ± 2% MVT vs. 80 ± 3% EVT; = 0.049). (4) Conclusions: The presented data suggest potential deterioration of renal function and intestinal mucosa function by an increase in tissue edema due to volume overload in ECMO therapy.
(1) 背景：液体复苏是体外膜肺氧合（ECMO）循环中维持足够血流动力学的治疗措施的必要组成部分。在一项事后分析中，我们旨在研究在大型动物模型中增加静脉 - 动脉ECMO循环中的容量治疗对肾功能和器官水肿的影响。(2) 方法：对12只雌性猪（德国长白猪×皮特兰猪）进行10小时的ECMO治疗，随后实施安乐死。根据血流动力学维持的需要，将适用的容量分为中度和大量容量治疗（MVT/EVT），这是基于计划研究期间计算出的生理尿量的两倍。连续测量呼吸和血流动力学数据。此外，通过血液和组织样本评估肾功能和器官水肿。(3) 结果：4只猪接受MVT，8只猪接受EVT。ECMO循环10小时后，两组在血流动力学和呼吸数据方面未见重大差异。ECMO支持10小时后，EVT组肌酐的相对变化显著更高（MVT组为1.3±0.3，EVT组为1.8±0.5；P = 0.033）。在比较EVT和MVT时，肺、心、肝和肾样本在器官水肿方面无明显差异。与MVT相比，EVT组肠组织的水肿百分比更高（MVT组为77±2%，EVT组为80±3%；P = 0.049）。(4) 结论：所呈现的数据表明，ECMO治疗中容量超负荷导致组织水肿增加，可能会使肾功能和肠黏膜功能恶化。
