Sandrio Stany, Krebs Joerg, Spanier Tobias, Beck Grietje, Thiel Manfred, Graf Peter Tobias
Department of Anesthesiology and Critical Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68165 Mannheim, Germany.
J Clin Med. 2025 Sep 8;14(17):6342. doi: 10.3390/jcm14176342.
: This study evaluated the effects of veno-arterial (V-A) and veno-venoarterial (V-VA) ECMO in a porcine model of septic endotoxemia-induced acute pulmonary arterial hypertension (PAH). Our hypotheses were as follows: (1) V-VA ECMO lowers pulmonary vascular resistance (PVR) by delivering oxygenated blood to the pulmonary circulation, and (2) both V-A and V-VA ECMO improve perfusion to vital organs while simultaneously unloading the right ventricle (RV). : Acute PAH was induced with lipopolysaccharide (LPS) in 34 pigs. Animals were randomized to either a control group without ECMO or to two groups receiving V-A or V-VA ECMO. : All animals developed PAH after one hour of LPS infusion: mean pulmonary artery pressure (PAP) increased significantly from 26 (24-30) mmHg to 40 (34-46) mmHg ( < 0.0001), and PVR increased from 314 (221-390) to 787 (549-1073) ( < 0.0001). Neither V-A nor V-VA ECMO significantly reduced PVR compared to controls. RV end-diastolic area increased in the control group [6.1 (4.3-8.6) cm vs. 8.5 (7.8-9.7) cm, = 0.2], but not in the V-A [4.7 (3.3-7.6) cm] and V-VA [4.3 (2.5-8.3) cm] ECMO groups. Blood flow in the cranial mesenteric artery and celiac trunk did not differ significantly with or without ECMO. : Elevating pulmonary artery oxygen tension through V-A or V-VA ECMO did not reduce PVR or PAP. However, both ECMO configurations effectively unloaded the RV and maintained perfusion to abdominal organs.
本研究在脓毒症内毒素血症诱导的急性肺动脉高压（PAH）猪模型中评估了静脉 - 动脉（V - A）和静脉 - 静脉 - 动脉（V - VA）体外膜肺氧合（ECMO）的效果。我们的假设如下：（1）V - VA ECMO通过向肺循环输送氧合血来降低肺血管阻力（PVR），（2）V - A和V - VA ECMO均可改善重要器官的灌注，同时减轻右心室（RV）的负荷。34只猪通过脂多糖（LPS）诱导急性PAH。动物被随机分为未接受ECMO的对照组或接受V - A或V - VA ECMO的两组。所有动物在输注LPS 1小时后均出现PAH：平均肺动脉压（PAP）从26（24 - 30）mmHg显著升高至40（34 - 46）mmHg（P < 0.0001），PVR从314（221 - 390）升高至787（549 - 1073）（P < 0.0001）。与对照组相比，V - A和V - VA ECMO均未显著降低PVR。对照组右心室舒张末期面积增加[6.1（4.3 - 8.6）cm²对8.5（7.8 - 9.7）cm²，P = 0.2]，但V - A [4.7（3.3 - 7.6）cm²]和V - VA [4.3（2.5 - 8.3）cm²] ECMO组未增加。无论有无ECMO，肠系膜上动脉和腹腔干的血流量均无显著差异。通过V - A或V - VA ECMO提高肺动脉氧张力并未降低PVR或PAP。然而，两种ECMO模式均有效减轻了右心室的负荷并维持了对腹部器官的灌注。
