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. 2021 Oct 25:8:754852.
doi: 10.3389/fcvm.2021.754852. eCollection 2021.

Monitoring Mitochondrial Partial Oxygen Pressure During Cardiac Arrest and Extracorporeal Cardiopulmonary Resuscitation. An Experimental Pilot Study in a Pig Model

Loes Mandigers  1 , Jan-Steffen Pooth  2 , Mark A Wefers Bettink  3 , Corstiaan A den Uil  1   4   5 , Domagoj Damjanovic  2 , Egbert G Mik  3 , Sam Brixius  2 , Diederik Gommers  1 , Georg Trummer  2 , Dinis Dos Reis Miranda  1
Affiliations

Monitoring Mitochondrial Partial Oxygen Pressure During Cardiac Arrest and Extracorporeal Cardiopulmonary Resuscitation. An Experimental Pilot Study in a Pig Model

Loes Mandigers et al. Front Cardiovasc Med. .

Abstract

Introduction: Ischemia and reperfusion are crucial in determining the outcome after cardiac arrest and can be influenced by extracorporeal cardiopulmonary resuscitation (ECPR). The effect of ECPR on the availability and level of oxygen in mitochondria remains unknown. The aim of this study was to find out if skin mitochondrial partial oxygen pressure (mitoPO2) measurements in cardiac arrest and ECPR are feasible and to investigate its course. Materials and Methods: We performed a feasibility test to determine if skin mitoPO2 measurements in a pig are possible. Next, we aimed to measure skin mitoPO2 in 10 experimental pigs. Measurements were performed using a cellular oxygen metabolism measurement monitor (COMET), at baseline, during cardiac arrest, and during ECPR using the controlled integrated resuscitation device (CIRD). Results: The feasibility test showed continuous mitoPO2 values. Nine experimental pigs could be measured. Measurements in six experimental pigs succeeded. Our results showed a delay until the initial spike of mitoPO2 after ECPR initiation in all six experimental tests. In two experiments (33%) mitoPO2 remained present after the initial spike. A correlation of mitoPO2 with mean arterial pressure (MAP) and arterial partial oxygen pressure measured by CIRD (CIRD-PaO2) seemed not present. One of the experimental pigs survived. Conclusions: This experimental pilot study shows that continuous measurements of skin mitoPO2 in pigs treated with ECPR are feasible. The delay in initial mitoPO2 and discrepancy of mitoPO2 and MAP in our small sample study could point to the possible value of additional measurements besides MAP to monitor the quality of tissue perfusion during cardiac arrest and ECPR.

Keywords: cardiac arrest; circulation monitoring; extracorporeal cardiopulmonary resuscitation; heart arrest; mitochondrial oxygen pressure.

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Conflict of interest statement

DR declares having received speaking fees from Xenios GmbH and HillRom GmbH. EM is listed as inventor on patents related to mitochondrial oxygen measurements held by the Academic Medical Center Amsterdam and the Erasmus Medical Center Rotterdam, the Netherlands. EM is founder and shareholder of Photonics Healthcare, a company that holds exclusive licenses to these patents and that markets the COMET system. DG is a member of the medical advisory board of Xenios GmbH and received travel expenses and speaker fees from Xenios and Maquet GmbH. GT is shareholder of Resuscitec GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Course of mitoPO2 and CIRD-PaO2 for the feasibility test. Course of mitoPO2 and CIRD-PaO2 in mmHg levels over time in seconds. VF, ventricular fibrillation; ECPR, extracorporeal cardiopulmonary resuscitation; CIRD-PaO2, arterial partial oxygen pressure measured by controlled integrated resuscitation device; mitoPO2, mitochondrial partial oxygen pressure.
Figure 2
Figure 2
Course of mitoPO2, CIRD-PaO2, and MAP for experimental tests case 1 and 2. Course of mitoPO2 and CIRD-PaO2 in mmHg levels at the left Y-axis and course of MAP in mmHg levels at the right Y-axis all over time in seconds. Case 1 at the above panel and case 2 at the below panel. VF, ventricular fibrillation; ECPR, extracorporeal cardiopulmonary resuscitation; CIRD-PaO2, arterial partial oxygen pressure measured by controlled integrated resuscitation device; mitoPO2, mitochondrial partial oxygen pressure.
Figure 3
Figure 3
Course of mitoPO2, CIRD-PaO2, and MAP for experimental tests case 3 and 4. Course of mitoPO2 and CIRD-PaO2 in mmHg levels at the left Y-axis and course of MAP in mmHg levels at the right Y-axis all over time in seconds. Case 3 at the above panel and case 4 at the below panel. VF, ventricular fibrillation; ECPR, extracorporeal cardiopulmonary resuscitation; CIRD-PaO2, arterial partial oxygen pressure measured by controlled integrated resuscitation device; mitoPO2, mitochondrial partial oxygen pressure.
Figure 4
Figure 4
Course of mitoPO2, CIRD-PaO2, and MAP for experimental tests case 5 and 6. Course of mitoPO2 and CIRD-PaO2 in mmHg levels at the left Y-axis and course of MAP in mmHg levels at the right Y-axis all over time in seconds. Case 5 at the above panel and case 6 at the below panel. VF, ventricular fibrillation; ECPR, extracorporeal cardiopulmonary resuscitation; CIRD-PaO2, arterial partial oxygen pressure measured by controlled integrated resuscitation device; mitoPO2, mitochondrial partial oxygen pressure.
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