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. 2023 Aug 16;12(16):5330.
doi: 10.3390/jcm12165330.

Fluid Management in Veno-Arterial Extracorporeal Membrane Oxygenation Therapy-Analysis of an Experimental Pig Model

Ilija Djordjevic  1 , Johanna Maier-Trauth  2 , Stephen Gerfer  1 , Mara Elskamp  1 , Thomas Muehlbauer  1 , Alexandra Maul  3 , Pia Rademann  3 , Borko Ivanov  2 , Ihor Krasivskyi  1 , Anton Sabashnikov  1 , Elmar Kuhn  1 , Ingo Slottosch  4 , Thorsten Wahlers  1 , Oliver Liakopoulos  5 , Antje Christin Deppe  1
Affiliations

Fluid Management in Veno-Arterial Extracorporeal Membrane Oxygenation Therapy-Analysis of an Experimental Pig Model

Ilija Djordjevic et al. J Clin Med. .

Abstract

(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; p = 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; p = 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.

Keywords: ECMO; fluid overload; fluid therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study protocol and assessed parameters.
Figure 2
Figure 2
Presentation of groups after dichotomization in moderate and extensive volume therapy.
Figure 3
Figure 3
Cumulative fluid input during 10 h of ECMO circulation for the EVT and MVT groups.
Figure 4
Figure 4
Cardiac index value over 10 h ECMO circulation.
Figure 5
Figure 5
Creatinine ratio after 10 h ECMO circulation.
Figure 6
Figure 6
Organ edema ratio after 10 h ECMO circulation.
Figure 7
Figure 7
Organ edema (%) after 10 h ECMO circulation.
See this image and copyright information in PMC

References

    1. Abrams D., Combes A., Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J. Am. Coll. Cardiol. 2014;63:2769–2778. doi: 10.1016/j.jacc.2014.03.046. - DOI - PubMed
    1. Sidebotham D., McGeorge A., McGuinness S., Edwards M., Willcox T., Beca J. Extracorporeal membrane oxygenation for treating severe cardiac and respiratory failure in adults: Part 2-technical considerations. J. Cardiothorac. Vasc. Anesth. 2010;24:164–172. doi: 10.1053/j.jvca.2009.08.002. - DOI - PubMed
    1. Sidebotham D. Troubleshooting adult ECMO. J. Extra Corpor. Technol. 2011;43:P27–P32. - PMC - PubMed
    1. Adrie C., Adib-Conquy M., Laurent I., Monchi M., Vinsonneau C., Fitting C., Fraisse F., Dinh-Xuan A.T., Carli P., Spaulding C., et al. Successful cardiopulmonary resuscitation after cardiac arrest as a “sepsis-like” syndrome. Circulation. 2002;106:562–568. doi: 10.1161/01.CIR.0000023891.80661.AD. - DOI - PubMed
    1. Heradstveit B.E., Guttormsen A.B., Langorgen J., Hammersborg S.M., Wentzel-Larsen T., Fanebust R., Larsson E.-M., Heltne J.-K. Capillary leakage in post-cardiac arrest survivors during therapeutic hypothermia—A prospective, randomised study. Scand. J. Trauma. Resusc. Emerg. Med. 2010;18:29. doi: 10.1186/1757-7241-18-29. - DOI - PMC - PubMed

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