Effect of flow change on brain injury during an experimental model of differential hypoxaemia in cardiogenic shock supported by extracorporeal membrane oxygenation

Autor: Sacha Rozencwajg, Silver Heinsar, Karin Wildi, Jae‐Seung Jung, Sebastiano Maria Colombo, Chiara Palmieri, Kei Sato, Carmen Ainola, Xiaomeng Wang, Gabriella Abbate, Noriko Sato, Wayne B. Dyer, Samantha Livingstone, Leticia Helms, Nicole Bartnikowski, Mahe Bouquet, Margaret R. Passmore, Kieran Hyslop, Bruno Vidal, Janice D. Reid, Daniel McGuire, Emily S. Wilson, Indrek Rätsep, Roberto Lorusso, Matthieu Schmidt, Jacky Y. Suen, Gianluigi Li Bassi, John F. Fraser
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Scientific Reports, Vol 13, Iss 1, Pp 1-11 (2023)
Druh dokumentu: article
ISSN: 2045-2322
DOI: 10.1038/s41598-023-30226-6
Popis: Abstract Differential hypoxaemia (DH) is common in patients supported by femoral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and can cause cerebral hypoxaemia. To date, no models have studied the direct impact of flow on cerebral damage. We investigated the impact of V-A ECMO flow on brain injury in an ovine model of DH. After inducing severe cardiorespiratory failure and providing ECMO support, we randomised six sheep into two groups: low flow (LF) in which ECMO was set at 2.5 L min−1 ensuring that the brain was entirely perfused by the native heart and lungs, and high flow (HF) in which ECMO was set at 4.5 L min−1 ensuring that the brain was at least partially perfused by ECMO. We used invasive (oxygenation tension—PbTO2, and cerebral microdialysis) and non-invasive (near infrared spectroscopy—NIRS) neuromonitoring, and euthanised animals after five hours for histological analysis. Cerebral oxygenation was significantly improved in the HF group as shown by higher PbTO2 levels (+ 215% vs − 58%, p = 0.043) and NIRS (67 ± 5% vs 49 ± 4%, p = 0.003). The HF group showed significantly less severe brain injury than the LF group in terms of neuronal shrinkage, congestion and perivascular oedema (p
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