In-line hemofiltration minimized extracorporeal membrane oxygenation-related inflammation in a porcine model

Abstract

We evaluated a pattern for connecting a hemofiltration apparatus after the ECMO oxygenator and observed the effects on the levels of inflammatory cytokines. All animals were anesthetized and ventilated, were randomly divided into 3 groups and observed for 24 h: S group (n = 6) received cannulation and heparin infusion; E group (n = 6) received venovenous (VV)-ECMO and heparin infusion; E+H group (n = 6) received hemofiltration with VV-ECMO placed after the oxygenator and heparin infusion. Hemodynamics, gas exchange parameters and plasma cytokine levels were measured simultaneously. After VV-ECMO, oxygenation was maintained in the E and E+H groups. In the E group, the levels of TNF-α, IL-1β, IL-6 and IL-8 increased markedly in the first 2-6 h and then remained stable from 12-24 h. Concentrations of TNF-α, IL-1β, IL-6 and IL-8 in the E+H group were lower than those in the E group. We concluded that the manner of connecting the hemofiltration apparatus after the oxygenator helped maintain adequate oxygenation and was easy to perform. Connecting hemofiltration to ECMO minimized the ECMO-associated effects of pro-inflammatory cytokines.

Keywords: C-reactive protein; cytokines; extracorporeal membrane oxygenation; hemofiltration; systemic inflammatory response.