Immediate inflammatory response to mechanical circulatory support in a porcine model of severe cardiogenic shock.

Autor: Gregers E; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen O, Denmark. Emilie.gregers@gmail.com., Frederiksen PH; Department of Cardiology, Odense University Hospital, Odense, Denmark., Udesen NLJ; Department of Cardiology, Odense University Hospital, Odense, Denmark., Linde L; Department of Cardiology, Odense University Hospital, Odense, Denmark., Banke A; Department of Cardiology, Odense University Hospital, Odense, Denmark., Povlsen AL; Department of Cardiology, Odense University Hospital, Odense, Denmark., Larsen JP; Department of Cardiothoracic Anesthesiology, Odense University Hospital, Odense, Denmark., Hassager C; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen O, Denmark., Jensen LO; Department of Cardiology, Odense University Hospital, Odense, Denmark., Lassen JF; Department of Cardiology, Odense University Hospital, Odense, Denmark., Schmidt H; Department of Cardiothoracic Anesthesiology, Odense University Hospital, Odense, Denmark., Ravn HB; Department of Cardiothoracic Anesthesiology, Odense University Hospital, Odense, Denmark., Heegaard PMH; Department of Health Technology, Technical University of Denmark, Lyngby, Denmark., Møller JE; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen O, Denmark.; Department of Cardiology, Odense University Hospital, Odense, Denmark.
Jazyk: angličtina
Zdroj: Intensive care medicine experimental [Intensive Care Med Exp] 2024 Apr 22; Vol. 12 (1), pp. 39. Date of Electronic Publication: 2024 Apr 22.
DOI: 10.1186/s40635-024-00625-8
Abstrakt: Background: In selected cases of cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is combined with trans valvular micro axial flow pumps (ECMELLA). Observational studies indicate that ECMELLA may reduce mortality but exposing the patient to two advanced mechanical support devices may affect the early inflammatory response. We aimed to explore inflammatory biomarkers in a porcine cardiogenic shock model managed with V-A ECMO or ECMELLA.
Methods: Fourteen landrace pigs had acute myocardial infarction-induced cardiogenic shock with minimal arterial pulsatility by microsphere embolization and were afterwards managed 1:1 with either V-A ECMO or ECMELLA for 4 h. Serial blood samples were drawn hourly and analyzed for serum concentrations of interleukin 6 (IL-6), IL-8, tumor necrosis factor alpha, and serum amyloid A (SAA).
Results: An increase in IL-6, IL-8, and SAA levels was observed during the experiment for both groups. At 2-4 h of support, IL-6 levels were higher in ECMELLA compared to V-A ECMO animals (difference: 1416 pg/ml, 1278 pg/ml, and 1030 pg/ml). SAA levels were higher in ECMELLA animals after 3 and 4 h of support (difference: 401 ng/ml and 524 ng/ml) and a significant treatment-by-time effect of ECMELLA on SAA was identified (p = 0.04). No statistical significant between-group differences were observed in carotid artery blood flow, urine output, and lactate levels.
Conclusions: Left ventricular unloading with Impella during V-A ECMO resulted in a more extensive inflammatory reaction despite similar end-organ perfusion.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje