Inflammation and lung injury in an ovine model of extracorporeal membrane oxygenation support

Extracorporeal membrane oxygenation (ECMO) is a life-saving treatment for patients with severe refractory cardiorespiratory failure. Exposure to the ECMO circuit is thought to trigger/exacerbate inflammation. Determining whether inflammation is the result of the patients' underlying pathologies or the ECMO circuit is difficult. To discern how different insults contribute to the inflammatory response, we developed an ovine model of lung injury and ECMO to investigate the impact of smoke-induced lung injury and ECMO in isolation and cumulatively on pulmonary and circulating inflammatory cells, cytokines, and tissue remodeling. Sheep receiving either smoke-induced acute lung injury (S-ALI) or sham injury were placed on veno-venous (VV) ECMO lasting either 2 or 24 h, with controls receiving conventional ventilation only. Lung tissue, bronchoalveolar fluid, and plasma were analyzed by RT-PCR, immunohistochemical staining, and zymography to assess inflammatory cells, cytokines, and matrix metalloproteinases. Pulmonary compliance decreased in sheep with S-ALI placed on ECMO with increased numbers of infiltrating neutrophils, monocytes, and alveolar macrophages compared with controls. Infiltration of neutrophils was also observed with S-ALI alone. RT-PCR studies showed higher expression of matrix metalloproteinases 2 and 9 in S-ALI plus ECMO, whereas IL-6 was elevated at 2 h. Zymography revealed higher levels of matrix metalloproteinase 2. Circulating plasma levels of IL-6 were elevated 1–2 h after commencement of ECMO alone. These data show that the inflammatory response is enhanced when a host with preexisting pulmonary injury is placed on ECMO, with increased infiltration of neutrophils and macrophages, the release of inflammatory cytokines, and upregulation of matrix metalloproteinases.

Download Full-text

Extracorporeal Membrane Oxygenation (ECMO) for Lung Injury in Severe Acute Respiratory Distress Syndrome (ARDS): Review of the Literature

Clinical Nursing Research ◽

10.1177/1054773816677808 ◽

2016 ◽

Vol 26 (6) ◽

pp. 747-762 ◽

Cited By ~ 7

Author(s):

Summer Paolone

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Lung Injury ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Future Research ◽

High Morbidity ◽

Ecmo Circuit ◽

Membrane Oxygenation

Despite advances in mechanical ventilation, severe acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality rates ranging from 26% to 58%. Extracorporeal membrane oxygenation (ECMO) is a modified cardiopulmonary bypass circuit that serves as an artificial membrane lung and blood pump to provide gas exchange and systemic perfusion for patients when their own heart and lungs are unable to function adequately. ECMO is a complex network that provides oxygenation and ventilation and allows the lungs to rest and recover from respiratory failure while minimizing iatrogenic ventilator-induced lung injury. In critical care settings, ECMO is proven to improve survival rates and outcomes in patients with severe ARDS. This review defines severe ARDS; describes the ECMO circuit; and discusses recent research, optimal use of the ECMO circuit, limitations of therapy including potential complications, economic impact, and logistical factors; and discusses future research considerations.

Download Full-text

The impact of pre-operative extracorporeal membrane oxygenation support on survival in lung transplantation surgery- ECMO as bridge to transplant

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0031-1297503 ◽

2012 ◽

Vol 60 (S 01) ◽

Author(s):

S Lehmann ◽

S Leontyev ◽

C Binner ◽

J Garbade ◽

MJ Barten ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Bridge To Transplant ◽

Membrane Oxygenation ◽

Transplantation Surgery ◽

The Impact

Download Full-text

Faculty Opinions recommendation of Near-Apneic Ventilation Decreases Lung Injury and Fibroproliferation in an Acute Respiratory Distress Syndrome Model with Extracorporeal Membrane Oxygenation.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.734014867.793559510 ◽

2019 ◽

Author(s):

Alain Vuylsteke ◽

Lucy Mwaura

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Lung Injury ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Membrane Oxygenation

Download Full-text

Effect of PEEP-Induced Alveolar Recruitment on Lung Injury during Extracorporeal Membrane Oxygenation for ARDS

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2019.01.851 ◽

2019 ◽

Vol 38 (4) ◽

pp. S337

Author(s):

B.M. Gomes ◽

R.V. Ribeiro ◽

K. Ramadan ◽

M. Galasso ◽

A. Ali ◽

...

Keyword(s):

Lung Injury ◽

Extracorporeal Membrane Oxygenation ◽

Alveolar Recruitment ◽

Membrane Oxygenation

Download Full-text

The impact of extracorporeal membrane oxygenation on cerebral oxygen delivery during cardiac arrest: a case series

Resuscitation Plus ◽

10.1016/j.resplu.2020.100068 ◽

2021 ◽

Vol 5 ◽

pp. 100068

Author(s):

Emma Roellke ◽

Sam Parnia ◽

Jignesh Patel ◽

Steven Friedman ◽

Amanda Mengotto

Keyword(s):

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Oxygen Delivery ◽

Case Series ◽

Cerebral Oxygen ◽

Membrane Oxygenation ◽

The Impact

Download Full-text

CT fatty muscle fraction as a new parameter for muscle quality assessment predicts outcome in venovenous extracorporeal membrane oxygenation

Scientific Reports ◽

10.1038/s41598-020-79495-5 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Anton Faron ◽

Stefan Kreyer ◽

Alois M. Sprinkart ◽

Thomas Muders ◽

Stefan F. Ehrentraut ◽

...

Keyword(s):

Skeletal Muscle ◽

Extracorporeal Membrane Oxygenation ◽

Adverse Outcomes ◽

Muscle Quality ◽

Imaging Biomarker ◽

Survival Prediction ◽

Multivariable Logistic Regression Model ◽

Muscle Area ◽

Membrane Oxygenation ◽

The Impact

AbstractImpaired skeletal muscle quality is a major risk factor for adverse outcomes in acute respiratory failure. However, conventional methods for skeletal muscle assessment are inapplicable in the critical care setting. This study aimed to determine the prognostic value of computed tomography (CT) fatty muscle fraction (FMF) as a biomarker of muscle quality in patients undergoing extracorporeal membrane oxygenation (ECMO). To calculate FMF, paraspinal skeletal muscle area was obtained from clinical CT and separated into areas of fatty and lean muscle based on densitometric thresholds. The cohort was binarized according to median FMF. Patients with high FMF displayed significantly increased 1-year mortality (72.7% versus 55.8%, P = 0.036) on Kaplan–Meier analysis. A multivariable logistic regression model was built to test the impact of FMF on outcome. FMF was identified as a significant predictor of 1-year mortality (hazard ratio per percent FMF, 1.017 [95% confidence interval, 1.002–1.033]; P = 0.031), independent of anthropometric characteristics, Charlson Comorbidity Index, Simplified Acute Physiology Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction Score, and duration of ECMO support. To conclude, FMF predicted 1-year mortality independently of established clinical prognosticators in ECMO patients and may have the potential to become a new muscle quality imaging biomarker, which is available from clinical CT.

Download Full-text

Reducing Broad Spectrum Antimicrobial Use in Extracorporeal Membrane Oxygenation (ECMO): Reduce AMMO Study

Clinical Infectious Diseases ◽

10.1093/cid/ciab118 ◽

2021 ◽

Author(s):

Aditya Shah ◽

Priya Sampathkumar ◽

Ryan W Stevens ◽

John K Bohman ◽

Brian D Lahr ◽

...

Keyword(s):

Time Series ◽

Extracorporeal Membrane Oxygenation ◽

Broad Spectrum ◽

Antimicrobial Prophylaxis ◽

Current Evidence ◽

Antimicrobial Use ◽

Infection Rates ◽

Interrupted Time Series Analysis ◽

Membrane Oxygenation ◽

The Impact

Abstract Background The use of extracorporeal membrane oxygenation (ECMO) in critically ill adults is increasing. There are currently no guidelines for antimicrobial prophylaxis. We analyzed 7 years of prophylactic antimicrobial use across three time series for patients on ECMO at our institution in the development, improvement, and streamlining of our ECMO antimicrobial prophylaxis protocol. Study design and Methods In this quasi-experimental interrupted time series analysis, we evaluated the impact of an initial ECMO antimicrobial prophylaxis protocol, implemented in 2014, on antimicrobial use and NHSN reportable infection rates. Then, following a revision and streamlining of the protocol in November 2018, we re-evaluated the same metrics. Results Our study population included 338 ICU patients who received ECMO between July 2011 and November 2019. After implementation of the first version of the protocol we did not observe significant changes in antimicrobial use or infection rates in these patients; however, following revision and streamlining of the protocol, we demonstrated a significant reduction in broad spectrum antimicrobial use for prophylaxis in patients on ECMO without any evidence of a compensatory increase in infection rates. Conclusion Our final protocol significantly reduces broad spectrum antimicrobial use for prophylaxis in patients on ECMO. We propose a standard antimicrobial prophylaxis regimen for patients on ECMO based on current evidence and our experience.

Download Full-text