Abstract
BackgroundIt is not yet clear whether hemofiltration can reduce blood cytokine levels sufficiently to benefit patients who suffer prolonged cardiac arrest (CA) treated with cardiopulmonary bypass (CPB). We sought to assess effects of high-volume and standard volume continuous veno-venous hemofiltration (CVVH) on blood cytokine levels and survival in a rat model of prolonged CA treated with CPB.MethodsSprague-Dawley male rats were subjected to 12 min of asphyxia to induce CA. CPB was initiated for resuscitation of animals and maintained for 30 min. Twenty-four rats were randomly assigned into three groups: without CVVH treatment (sham); standard volume CVVH at a filtration rate of 35–45 mL/kg/h; and high-volume hemofiltration (HVHF, 105–135 mL/kg/h). Hemofiltration was started simultaneously with CPB and maintained for 6 h. Plasma TNFα and IL-6 levels were measured at baseline, 0.5, 1, 2, 3, and 6 h after reperfusion. Survival time, neurological deficit score, and hemodynamic status were assessed.ResultsAll animals survived over 6 h and died within 24 h. There were no significant differences in survival time (log-rank test, sham vs. CVVH; p = 0.49, sham vs. HVHF; p = 0.33) or neurological deficit scores (ANOVA, p = 0.14) between the groups. There were no significant differences in blood cytokine levels between the groups. Mean blood pressure in sham group animals increased to 1.5-fold higher than baseline levels at 30 min. HVHF significantly reduced blood pressure to 0.7-fold of sham group (p < 0.01).ConclusionsThere was no improvement in mortality, neurological dysfunction, TNFα, or IL-6 levels in rats after prolonged CA with CPB on either hemofiltration group when compared to the sham group.Electronic supplementary materialThe online version of this article (doi:10.1186/s40635-016-0101-6) contains supplementary material, which is available to authorized users.
Highlights
It is not yet clear whether hemofiltration can reduce blood cytokine levels sufficiently to benefit patients who suffer prolonged cardiac arrest (CA) treated with cardiopulmonary bypass (CPB)
In order to understand the effect of hemofiltration rates on blood cytokine levels and outcomes of refractory CA victims, we evaluated the efficacy of high (105–135 mL/kg/h) or standard (35–45 mL/kg/h) filtration rates of continuous veno-venous hemofiltration (CVVH) on blood cytokine levels and survival in rats after prolonged CA treated with CPB
Neither standard volume continuous veno-venous hemofiltration nor high-volume hemofiltration had any effect on blood TNFα or IL-6 levels in a rodent model of prolonged CA treated with CPB
Summary
It is not yet clear whether hemofiltration can reduce blood cytokine levels sufficiently to benefit patients who suffer prolonged cardiac arrest (CA) treated with cardiopulmonary bypass (CPB). A method to regulate the highly activated systematic inflammatory response that occurs after refractory CA with CPB is of growing interest in post-cardiac arrest syndrome (PCAS) [4, 6,7,8]. Inflammatory cytokines, such as TNFα and interleukin-6 (IL-6), are key mediators of sepsis [9,10,11] and of PCAS [4]. The clinical application of CVVH to critically injured patients with ischemia/reperfusion is still controversial [18, 19]
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