ECMO attenuates inflammation response and increases ATPase activity in brain of swine model with cardiac arrest compared with CCPR

Zhang, Yun; Liu, Chunsheng; Yuan, Xiaoli; Ling, Ji-Yang; Zhang, Qiang; Liu, Bo; Zhao, Lianxing

doi:10.1042/bsr20182463

Cited by 9 publications

(10 citation statements)

References 50 publications

(37 reference statements)

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“…48 Additionally, CPB resuscitation is different from manual or mechanical CPR, and while providing consistent and standardised blood flow, the extracorporeal circulation may contribute to the severity of the sepsis-like syndrome commonly observed after cardiac arrest. 49 We used vasoactive agents to reach and maintain the targeted MAP, and these drugs may have effects that could influence the results. The use of noradrenaline to maintain target MAP is recommended in current post-resuscitation guidelines, whereas titrating nitroprusside to MAP60 is not common practiceand may have had unintentional and clinically relevant effects on CBF.…”

Section: Limitationsmentioning

confidence: 99%

Cerebral perfusion and metabolism with mean arterial pressure 90 vs. 60 mmHg in a porcine post cardiac arrest model with and without targeted temperature management

et al. 2021

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Aim: To determine whether targeting a mean arterial pressure of 90 mmHg (MAP90) would yield improved cerebral blood flow and less ischaemia compared to MAP 60 mmHg (MAP60) with and without targeted temperature management at 33 C (TTM33) in a porcine post-cardiac arrest model. Methods: After 10 min of cardiac arrest, 41 swine of either sex were resuscitated until return of spontaneous circulation (ROSC). They were randomised to TTM33 or no-TTM, and MAP60 or MAP90; yielding four groups. Temperatures were managed with intravasal cooling and blood pressure targets with noradrenaline, vasopressin and nitroprusside, as appropriate. After 30 min of stabilisation, animals were observed for two hours. Cerebral perfusion pressure (CPP), cerebral blood flow (CBF), pressure reactivity index (PRx), brain tissue pCO 2 (PbtCO 2 ) and tissue intermediary metabolites were measured continuously and compared using mixed models.Results: Animals randomised to MAP90 had higher CPP (p < 0.001 for both no-TTM and TTM33) and CBF (no-TTM, p < 0.03; TH, p < 0.001) compared to MAP60 during the 150 min observational period post-ROSC. We also observed higher lactate and pyruvate in MAP60 irrespective of temperature, but no significant differences in PbtCO 2 and lactate/pyruvate-ratio. We found lower PRx (indicating more intact autoregulation) in MAP90 vs. MAP60 (no-TTM, p = 0.04; TTM33, p = 0.03). Conclusion:In this porcine cardiac arrest model, targeting MAP90 led to better cerebral perfusion and more intact autoregulation, but without clear differences in ischaemic markers, compared to MAP60.

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Section: Limitationsmentioning

confidence: 99%

Cerebral perfusion and metabolism with mean arterial pressure 90 vs. 60 mmHg in a porcine post cardiac arrest model with and without targeted temperature management

et al. 2021

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“…ECMO alleviates the neuro-inflammatory response in brain tissue. Zhang et al ( 31 ) in a porcine cardiac arrest model, found that IL-1, IL-6, TNF-α, and TGF-β levels were significantly lower in the ECMO group than in the CCPR group, while the difference in IL-10 levels between the two groups was not statistically significant. Pastuszko et al ( 34 ) investigated the effect of ECMO on pro-inflammatory signaling in the striatum of piglets after CA and found that ECMO significantly reduced pro-inflammatory proteins (IL-12p40, IL-21, IL-15, IL-1α, and β, IL-8, MIP-1β, OPG, PIGF-2, RANTES, and TGF-β).…”

Section: Mechanisms Of Ecmo In Preventing Cerebral Injury Induced By Camentioning

confidence: 98%

“…Zhang et al ( 31 ) found that ECMO could improve ATPase activity compared to CCPR in a porcine model of CA. It has also been found that ECPR treatment of CA in rats has a protective effect on neurons after CA, and the mechanism may be related to improved energy metabolism in the brain ( 32 ).…”

Section: Mechanisms Of Ecmo In Preventing Cerebral Injury Induced By Camentioning

confidence: 99%

The effects of ECMO on neurological function recovery of critical patients: A double-edged sword

et al. 2023

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Extracorporeal membrane oxygenation (ECMO) played an important role in the treatment of patients with critical care such as cardiac arrest (CA) and acute respiratory distress syndrome. ECMO is gradually showing its advantages in terms of speed and effectiveness of circulatory support, as it provides adequate cerebral blood flow (CBF) to the patient and ensures the perfusion of organs. ECMO enhances patient survival and improves their neurological prognosis. However, ECMO-related brain complications are also important because of the high risk of death and the associated poor outcomes. We summarized the reported complications related to ECMO for patients with CA, such as north–south syndrome, hypoxic–ischemic brain injury, cerebral ischemia–reperfusion injury, impaired intracranial vascular autoregulation, embolic stroke, intracranial hemorrhage, and brain death. The exact mechanism of ECMO on the role of brain function is unclear. Here we review the pathophysiological mechanisms associated with ECMO in the protection of neurologic function in recent years, as well as the ECMO-related complications in brain and the means to improve it, to provide ideas for the treatment of brain function protection in CA patients.

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“…2 An experimental animal study showed that, especially early after initiation of ECPR, cardiac output, and MAP are higher in ECPR than in ROSC after conventional CPR (CCPR). 4 When comparing ECPR with a non-pulsatile blood flow and MAP 40-60 mmHg strategy to ECPR with a pulsatile blood flow and MAP 100-120 mmHg strategy, higher markers of cardiac injury and lower favorable neurological survival were found in the non-pulsatile group. 5 Two meta-analyses and the first randomized controlled trial (RCT) showed higher rates of favorable neurological survival in ECPR than in CCPR-treated patients.…”

Section: Introductionmentioning

confidence: 99%

“…The effects of these rapid fluctuations in the direct post‐resuscitation phase are unknown 2 . An experimental animal study showed that, especially early after initiation of ECPR, cardiac output, and MAP are higher in ECPR than in ROSC after conventional CPR (CCPR) 4 . When comparing ECPR with a non‐pulsatile blood flow and MAP 40–60 mmHg strategy to ECPR with a pulsatile blood flow and MAP 100–120 mmHg strategy, higher markers of cardiac injury and lower favorable neurological survival were found in the non‐pulsatile group 5 …”

Section: Introductionmentioning

confidence: 99%

Higher mean cerebral oxygen saturation shortly after extracorporeal cardiopulmonary resuscitation in patients who regain consciousness

et al. 2023

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IntroductionIn cardiac arrest, cerebral ischemia and reperfusion injury mainly determine the neurological outcome. The aim of this study was to investigate the relation between the course of cerebral oxygenation and regain of consciousness in patients treated with extracorporeal cardiopulmonary resuscitation (ECPR). We hypothesized that rapid cerebral oxygenation increase causes unfavorable outcomes.MethodsThis prospective observational study was conducted in three European hospitals. We included adult ECPR patients between October 2018 and March 2020, in whom cerebral regional oxygen saturation (rSO2) measurements were started minutes before ECPR initiation until 3 h after. The primary outcome was regain of consciousness, defined as following commands, analyzed using binary logistic regression.ResultsThe sample consisted of 26 ECPR patients (23% women, Agemean 46 years). We found no significant differences in rSO2 values at baseline (49.1% versus 49.3% for regain versus no regain of consciousness). Mean cerebral rSO2 values in the first 30 min after ECPR initiation were higher in patients who regained consciousness (38%) than in patients who did not regain consciousness (62%, odds ratio 1.23, 95% confidence interval 1.01–1.50).ConclusionHigher mean cerebral rSO2 values in the first 30 min after initiation of ECPR were found in patients who regained consciousness.

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ECMO attenuates inflammation response and increases ATPase activity in brain of swine model with cardiac arrest compared with CCPR

Cited by 9 publications

References 50 publications

Cerebral perfusion and metabolism with mean arterial pressure 90 vs. 60 mmHg in a porcine post cardiac arrest model with and without targeted temperature management

Cerebral perfusion and metabolism with mean arterial pressure 90 vs. 60 mmHg in a porcine post cardiac arrest model with and without targeted temperature management

The effects of ECMO on neurological function recovery of critical patients: A double-edged sword

Higher mean cerebral oxygen saturation shortly after extracorporeal cardiopulmonary resuscitation in patients who regain consciousness

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