Abstract
Background:
During extracorporeal membrane oxygenation (ECMO), circulation of blood across synthetic surfaces triggers an inflammatory response. Therefore, we evaluated the ability of continuous renal replacement therapy (CRRT) to remove cytokines and reduce the inflammatory response in a piglet hemorrhage–reperfusion ECMO model.
Methods:
Three groups were studied: (i) uninjured controls (n = 11); (ii) hemorrhage–reperfusion while on venoarterial ECMO (30% hemorrhage with subsequent blood volume replacement within 60 min) (n = 8); (iii) treatment with CRRT after hemorrhage–reperfusion while on ECMO (n = 7). Hemodynamic parameters, oxygen utilization, and plasma and broncho-alveolar lavage (BAL) cytokine levels were recorded and lung tissue samples collected for histologic comparison.
Results:
Whereas mean arterial pressures decreased among hemorrhage–reperfusion piglets, ECMO with CRRT did not significantly alter mean arterial pressures or systemic vascular resistance and was able to maintain blood flow as well as oxygen delivery after hemorrhage–reperfusion. Plasma interleukin (IL)-6 and IL-10, and BAL tumor necrosis factor (TNF)-α, IL-1β, IL-6, IL-8, and IL-10 increased as a result of hemorrhage–reperfusion while on ECMO. After a 6-h period of CRRT, plasma IL-6 and BAL TNF-α, IL-6, and IL-8 levels decreased.
Conclusion:
Data suggest CRRT may decrease inflammatory cytokine levels during the initial phase of ECMO therapy following hemorrhage–reperfusion while maintaining cardiac output and oxygen utilization.
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Acknowledgements
We thank Aileen Sato, Claudia Hernandez, Wayne Ichimura, January Andaya, Lee-Ann Murata, Glenn Hashiro, Solomon Nair, Tabitha Smith, Matt Ursery, Norman Kreiselmeier, Joseph Anderson, Jacob Espinosa, and Michael Lustik for their tireless support and dedication to this project.
The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US government.
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Mu, T., Palmer, E., Batts, S. et al. Continuous renal replacement therapy to reduce inflammation in a piglet hemorrhage–reperfusion extracorporeal membrane oxygenation model. Pediatr Res 72, 249–255 (2012). https://doi.org/10.1038/pr.2012.69
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DOI: https://doi.org/10.1038/pr.2012.69
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