BIO9: The Addition of High Molecular Weight Linear Polymers Improves Microvascular Perfusion in an Animal Model of Veno-arterial Extracorporeal Circulation.

Abstract

High molecular weight linear polymers have been used in turbulent flow applications such as crude oil transfer to reduce drag. These polymers have branched into bioengineering applications to improve pressure changes within the macrocirculation and improve RBC distribution within the microcirculation. The current study aims to determine whether the addition of these polymers to priming fluids used for veno-arterial extracorporeal circulation (VA-ECC) procedures improve microvascular flow and tissue oxygenation. To assess the microcirculation, male Golden Syrian hamsters were instrumented with a dorsal skinfold window chamber, and an exteriorized carotid artery catheter was implanted for arterial blood and blood pressure access. After baseline (BL) measurements were taken, the hamster underwent surgery under isoflurane to insert a drainage catheter into the jugular vein. A heparin bolus (0.05 IU/g) was then provided, and the animal was connected to the VA-ECC circuit. The circuit, consisting of a peristaltic pump and bubble trap, was primed with lactated ringers (LR, control), LR with 5 ppm of 500 kDa polyethylene glycol (PEG500k) or LR with 5 ppm of 3500kDa polyethylene glycol (PEG3500k). Blood flow was ramped up over 15 minutes, maintained at 15% of the animal’s cardiac output for 60 minutes, then ramped down over 15 minutes. The animal was then surgically closed and placed on a heating pad and allowed at least 30 minutes to wake up from the anesthetic plane before taking measurements at 1, 2, and 24 hours after VA-ECC. Capillary perfusion (Figure 1) within the skinfold preparation showed a significant decrease immediately post-ECC for all three groups. However, the PEG3500k group consistently showed significant increase in functional capillary density (FCD) as compared to both other groups after ECC. 24 hrs after ECC, FCD was recovered close to BL levels for both PEG groups, while the LR control did not. Arteriole and venule velocity (Figure 2) was significantly elevated at both 1 and 2 hrs post-ECC for the PEG3500k group when compared to the other two groups. Arteriole flow for the PEG3500k was significantly improved over the LR control at 24 hrs post-ECC, and was significantly higher than BL levels. Hemoglobin saturation within arterioles and venules (Figure 3) revealed that PEG3500k had higher venule saturation at 1 and 2 hrs post-ECC compared to both other groups. The results indicate that the use of PEG3500k improved microvascular perfusion acutely post-ECC, and continued to up to 24 hrs afterwards. The most important changes were in arteriole perfusion and FCD, since that directly impacts oxygen delivery and metabolic washout respectively. Ultimately, this aids in maintaining organ function and preventing the development of ischemic injury and inflammatory cascades. Future studies could optimize the molecular weight, concentration, and type of polymer, along with testing in a clinical ECC circuit to determine hemodynamic changes.Figure 1. Functional capillary density (FCD), normalized to baseline (BL, represented by the dotted line). † P < 0.05 as compared to BL, within each group. * P < 0.05; ** P < 0.01; *** P < 0.001 between groups, at each timepoint.Figure 2. Perfusion within the microcirculation. From top to bottom: diameter, velocity, blood flow. Arterioles are on the left, while venules are on the right. Note that all values were normalized to baseline (BL, represented by the dashed line) and that blood flow was calculated from the diameter and velocity measurements of each vessel. Bar plots represent mean and standard deviation. † P < 0.05 as compared to BL, within each group. * P < 0.05; ** P < 0.01; *** P < 0.001; **** P < 0.0001 between groups, at each timepoint.Figure 3. Hemoglobin oxygen saturation within the microcirculation. Top = arterioles, bottom = venules. Bar plots show mean and standard deviation. † P < 0.05 as compared to BL, within each group. * P < 0.05; ** P < 0.01; *** P < 0.001; **** P < 0.0001 between groups, at each timepoint.