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

Yun Zhang,Qiang Zhang,Bo Liu,Yong Liang,Xiao-Li Yuan,Ji-Yang Ling,Chun-Sheng Li,Lian-Xing Zhao

doi:10.1042/bsr20182463

Yun Zhang, Qiang Zhang + Show 6 more

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https://doi.org/10.1042/bsr20182463

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Abstract

Extracorporeal membrane oxygenation (ECMO) could increase survival rate and neurological outcomes of cardiac arrest (CA) patients compared with conventional cardiopulmonary resuscitation (CCPR). Currently, the underlying mechanisms how ECMO improves neurological outcomes of CA patients compared with CCPR have not been revealed. A pig model of CA was established by ventricular fibrillation induction and then underwent CCPR or ECMO. Survival and hemodynamics during the 6 h after return of spontaneous circulation (ROSC) were compared. The levels of inflammatory cytokines and Ca2+-ATPase and NA+-K+-ATPase activities were detected. Brain tissues histology and ultra-microstructure in CCPR and ECMO groups were also examined. Results suggested that ECMO significantly improved the survival of pigs compared with CCPR. Heart rate (HR) decreased while cardiac output (CO) increased along with the time after ROSC in both ECMO and CCPR groups. At each time point, HR in ECMO groups was lower than that in CCPR group while CO and mean arterial pressure in ECMO group was higher than CCPR group. In ECMO group, lower levels of IL-1, IL-1β, IL-6, TNFα, and TGFβ, especially IL-1, IL-6, TNFα, and TGFβ, were found compared that in CCPR group while no difference of IL-10 between the two groups was observed. Similar with the results from enzyme-linked immunosorbent assay, decreased expressions of IL-6 and TGFβ were also identified by Western blotting. And Ca2+-ATPase and NA+-K+-ATPase activities were increased by ECMO compared with CCPR. Hematoxylin and eosin staining and ultra-microstructure examination also revealed an improved inflammation situation in ECMO group compared with CCPR group.

Highlights

Cardiac arrest (CA), with very poor survival and neurological outcome, is the leading cause of sudden death and accounts for appropriate half of all cardiac deaths [1,2,3,4,5]
During 6 h-follow up after return of spontaneous circulation (ROSC), the following 6 h observation after ROSC, 100% (8/8) swine survived in extracorporeal membrane oxygenation (ECMO) groups while 50% (4/8) swine survived in conventional cardiopulmonary resuscitation (CCPR) group (Figure 1)
ECMO, as an alternative resuscitative method, has been more increasingly and wildly used for refractory CA and improves survival rate and neurological outcomes in both OHCA and in of hospital CA (IHCA) compared with CCPR [18]

Summary

Introduction

Cardiac arrest (CA), with very poor survival and neurological outcome, is the leading cause of sudden death and accounts for appropriate half of all cardiac deaths [1,2,3,4,5]. A series of recent studies suggested that, compared with conventional cardiopulmonary resuscitation (CCPR), extracorporeal cardiopulmonary resuscitation (ECPR) with ECMO strategies may improve survival and neurological outcomes in both out of hospital CA (OHCA) and in of hospital CA (IHCA), especially in IHCA [8,9,10,11,12]. Suggested that the use of ECMO is associated with an absolute increase of 30-day survival of 13% compared with patients not receiving ECMO and a higher rate of favorable neurological outcome at 30-days [18]. The underling mechanisms that ECMO is associated with more favorable neurological outcomes compared with CCPR in CA patients are not clear. We hypothesized that ECMO exerts protective effects on brain via attenuating inflammation in brain and contributes to a high survival rate and favorable neurological outcomes. The brain inflammation in CA after ECMO and CCPR has not been investigated

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