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Effect of flow change on brain injury during an experimental model of differential hypoxaemia in cardiogenic shock supported by extracorporeal membrane oxygenation
Differential hypoxaemia (DH) is common in patients supported by femoral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and can cause cerebral hypoxaemia. To date, no models have studied the direct impact of flow on cerebral damage. We investigated the impact of V-A ECMO flow on brain i...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10006234/ https://www.ncbi.nlm.nih.gov/pubmed/36899029 http://dx.doi.org/10.1038/s41598-023-30226-6 |
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author | Rozencwajg, Sacha Heinsar, Silver Wildi, Karin Jung, Jae‐Seung Colombo, Sebastiano Maria Palmieri, Chiara Sato, Kei Ainola, Carmen Wang, Xiaomeng Abbate, Gabriella Sato, Noriko Dyer, Wayne B. Livingstone, Samantha Helms, Leticia Bartnikowski, Nicole Bouquet, Mahe Passmore, Margaret R. Hyslop, Kieran Vidal, Bruno Reid, Janice D. McGuire, Daniel Wilson, Emily S. Rätsep, Indrek Lorusso, Roberto Schmidt, Matthieu Suen, Jacky Y. Bassi, Gianluigi Li Fraser, John F. |
author_facet | Rozencwajg, Sacha Heinsar, Silver Wildi, Karin Jung, Jae‐Seung Colombo, Sebastiano Maria Palmieri, Chiara Sato, Kei Ainola, Carmen Wang, Xiaomeng Abbate, Gabriella Sato, Noriko Dyer, Wayne B. Livingstone, Samantha Helms, Leticia Bartnikowski, Nicole Bouquet, Mahe Passmore, Margaret R. Hyslop, Kieran Vidal, Bruno Reid, Janice D. McGuire, Daniel Wilson, Emily S. Rätsep, Indrek Lorusso, Roberto Schmidt, Matthieu Suen, Jacky Y. Bassi, Gianluigi Li Fraser, John F. |
author_sort | Rozencwajg, Sacha |
collection | PubMed |
description | Differential hypoxaemia (DH) is common in patients supported by femoral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and can cause cerebral hypoxaemia. To date, no models have studied the direct impact of flow on cerebral damage. We investigated the impact of V-A ECMO flow on brain injury in an ovine model of DH. After inducing severe cardiorespiratory failure and providing ECMO support, we randomised six sheep into two groups: low flow (LF) in which ECMO was set at 2.5 L min(−1) ensuring that the brain was entirely perfused by the native heart and lungs, and high flow (HF) in which ECMO was set at 4.5 L min(−1) ensuring that the brain was at least partially perfused by ECMO. We used invasive (oxygenation tension—PbTO(2), and cerebral microdialysis) and non-invasive (near infrared spectroscopy—NIRS) neuromonitoring, and euthanised animals after five hours for histological analysis. Cerebral oxygenation was significantly improved in the HF group as shown by higher PbTO(2) levels (+ 215% vs − 58%, p = 0.043) and NIRS (67 ± 5% vs 49 ± 4%, p = 0.003). The HF group showed significantly less severe brain injury than the LF group in terms of neuronal shrinkage, congestion and perivascular oedema (p < 0.0001). Cerebral microdialysis values in the LF group all reached the pathological thresholds, even though no statistical difference was found between the two groups. Differential hypoxaemia can lead to cerebral damage after only a few hours and mandates a thorough neuromonitoring of patients. An increase in ECMO flow was an effective strategy to reduce such damages. |
format | Online Article Text |
id | pubmed-10006234 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-100062342023-03-12 Effect of flow change on brain injury during an experimental model of differential hypoxaemia in cardiogenic shock supported by extracorporeal membrane oxygenation Rozencwajg, Sacha Heinsar, Silver Wildi, Karin Jung, Jae‐Seung Colombo, Sebastiano Maria Palmieri, Chiara Sato, Kei Ainola, Carmen Wang, Xiaomeng Abbate, Gabriella Sato, Noriko Dyer, Wayne B. Livingstone, Samantha Helms, Leticia Bartnikowski, Nicole Bouquet, Mahe Passmore, Margaret R. Hyslop, Kieran Vidal, Bruno Reid, Janice D. McGuire, Daniel Wilson, Emily S. Rätsep, Indrek Lorusso, Roberto Schmidt, Matthieu Suen, Jacky Y. Bassi, Gianluigi Li Fraser, John F. Sci Rep Article Differential hypoxaemia (DH) is common in patients supported by femoral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and can cause cerebral hypoxaemia. To date, no models have studied the direct impact of flow on cerebral damage. We investigated the impact of V-A ECMO flow on brain injury in an ovine model of DH. After inducing severe cardiorespiratory failure and providing ECMO support, we randomised six sheep into two groups: low flow (LF) in which ECMO was set at 2.5 L min(−1) ensuring that the brain was entirely perfused by the native heart and lungs, and high flow (HF) in which ECMO was set at 4.5 L min(−1) ensuring that the brain was at least partially perfused by ECMO. We used invasive (oxygenation tension—PbTO(2), and cerebral microdialysis) and non-invasive (near infrared spectroscopy—NIRS) neuromonitoring, and euthanised animals after five hours for histological analysis. Cerebral oxygenation was significantly improved in the HF group as shown by higher PbTO(2) levels (+ 215% vs − 58%, p = 0.043) and NIRS (67 ± 5% vs 49 ± 4%, p = 0.003). The HF group showed significantly less severe brain injury than the LF group in terms of neuronal shrinkage, congestion and perivascular oedema (p < 0.0001). Cerebral microdialysis values in the LF group all reached the pathological thresholds, even though no statistical difference was found between the two groups. Differential hypoxaemia can lead to cerebral damage after only a few hours and mandates a thorough neuromonitoring of patients. An increase in ECMO flow was an effective strategy to reduce such damages. Nature Publishing Group UK 2023-03-10 /pmc/articles/PMC10006234/ /pubmed/36899029 http://dx.doi.org/10.1038/s41598-023-30226-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Article Rozencwajg, Sacha Heinsar, Silver Wildi, Karin Jung, Jae‐Seung Colombo, Sebastiano Maria Palmieri, Chiara Sato, Kei Ainola, Carmen Wang, Xiaomeng Abbate, Gabriella Sato, Noriko Dyer, Wayne B. Livingstone, Samantha Helms, Leticia Bartnikowski, Nicole Bouquet, Mahe Passmore, Margaret R. Hyslop, Kieran Vidal, Bruno Reid, Janice D. McGuire, Daniel Wilson, Emily S. Rätsep, Indrek Lorusso, Roberto Schmidt, Matthieu Suen, Jacky Y. Bassi, Gianluigi Li Fraser, John F. Effect of flow change on brain injury during an experimental model of differential hypoxaemia in cardiogenic shock supported by extracorporeal membrane oxygenation |
title | Effect of flow change on brain injury during an experimental model of differential hypoxaemia in cardiogenic shock supported by extracorporeal membrane oxygenation |
title_full | Effect of flow change on brain injury during an experimental model of differential hypoxaemia in cardiogenic shock supported by extracorporeal membrane oxygenation |
title_fullStr | Effect of flow change on brain injury during an experimental model of differential hypoxaemia in cardiogenic shock supported by extracorporeal membrane oxygenation |
title_full_unstemmed | Effect of flow change on brain injury during an experimental model of differential hypoxaemia in cardiogenic shock supported by extracorporeal membrane oxygenation |
title_short | Effect of flow change on brain injury during an experimental model of differential hypoxaemia in cardiogenic shock supported by extracorporeal membrane oxygenation |
title_sort | effect of flow change on brain injury during an experimental model of differential hypoxaemia in cardiogenic shock supported by extracorporeal membrane oxygenation |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10006234/ https://www.ncbi.nlm.nih.gov/pubmed/36899029 http://dx.doi.org/10.1038/s41598-023-30226-6 |
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