TY - JOUR
T1 - Cytokine removal on extracorporeal life support for treatment of acute endotoxemia: A randomized controlled animal study
AU - Weerwind, Patrick W.
AU - van der Veen, Frederik
AU - Gelsomino, Sandro
AU - Nagaraj, Naveen Gaddehosur
AU - Parise, Orlando
AU - Lorusso, Roberto
AU - Gensini, Gian Franco
AU - Maessen, Jos G.
PY - 2013/10/12
Y1 - 2013/10/12
N2 - Background: We prospectively evaluated the effectiveness of resin adsorption incorporated in an extracorporeal life support (ELS) circuit in an animal model of sepsis for removal of cytokines and prevention of hemodynamic deterioration during the treatment of septic shock. Methods: Twelve female landrace pigs were randomly assigned to two groups, a study group(n = 6), treated with high-flow resin adsorption (300 mL/min) and ELS, and a control group (n = 6), treated only with ELS. Septic shock was induced by intravenous 0.02 mu g/kg/min infusion was of Escherichia coli lipopolysaccharide (LPS). Measurements were carried out in the study group at baseline, at the end of LPS injection(t(0)) at 30(t(1)), 60(t(2)), 90(t(3)) and 120 min (t(4)) and 60 min after stopping resin-adsorption (t(5)). In the control group measurements were performed at baseline (t(0)), t(1) and only t(2), as no control animal survived beyond this latter experimental timepoint. Results: The final population consisted of 9 animals, five in the study group and 4 in the control group. Plasma values of both tumor necrosis factor a (TNF-alpha) and interleukin-6 (IL-6) were reduced during resin-adsorption (t(1)-t(4)) while these mediators increased in controls undergoing ELS only. With a clearance of TNF-alpha of 15,233 pg/min and IL-6 of 10,233 mu g/min, 79.2% of TNF-alpha and 95.3% of IL-6 produced were adsorbed. Systemic vascular resistance decreased significantly in both groups at t(0). While it further was reduced during the control experiments at t(1) and t(2), it returned to normal in the study animals. Cardiac output increased at t(0), t(1) and t(2) in the control experiments. In contrast, in study animals after a peak at t(0), it returned to the baseline value and did not vary thereafter. Conclusions: Combined resin-adsorption and ELS improved hemodynamics resulting from effective removal of inflammatory mediators in a pig model of septic shock.
AB - Background: We prospectively evaluated the effectiveness of resin adsorption incorporated in an extracorporeal life support (ELS) circuit in an animal model of sepsis for removal of cytokines and prevention of hemodynamic deterioration during the treatment of septic shock. Methods: Twelve female landrace pigs were randomly assigned to two groups, a study group(n = 6), treated with high-flow resin adsorption (300 mL/min) and ELS, and a control group (n = 6), treated only with ELS. Septic shock was induced by intravenous 0.02 mu g/kg/min infusion was of Escherichia coli lipopolysaccharide (LPS). Measurements were carried out in the study group at baseline, at the end of LPS injection(t(0)) at 30(t(1)), 60(t(2)), 90(t(3)) and 120 min (t(4)) and 60 min after stopping resin-adsorption (t(5)). In the control group measurements were performed at baseline (t(0)), t(1) and only t(2), as no control animal survived beyond this latter experimental timepoint. Results: The final population consisted of 9 animals, five in the study group and 4 in the control group. Plasma values of both tumor necrosis factor a (TNF-alpha) and interleukin-6 (IL-6) were reduced during resin-adsorption (t(1)-t(4)) while these mediators increased in controls undergoing ELS only. With a clearance of TNF-alpha of 15,233 pg/min and IL-6 of 10,233 mu g/min, 79.2% of TNF-alpha and 95.3% of IL-6 produced were adsorbed. Systemic vascular resistance decreased significantly in both groups at t(0). While it further was reduced during the control experiments at t(1) and t(2), it returned to normal in the study animals. Cardiac output increased at t(0), t(1) and t(2) in the control experiments. In contrast, in study animals after a peak at t(0), it returned to the baseline value and did not vary thereafter. Conclusions: Combined resin-adsorption and ELS improved hemodynamics resulting from effective removal of inflammatory mediators in a pig model of septic shock.
KW - Sepsis
KW - Resin adsorption
KW - Cytokine removal
KW - Extracorporeal life support
U2 - 10.1016/j.ijcard.2013.07.175
DO - 10.1016/j.ijcard.2013.07.175
M3 - Article
C2 - 23954008
VL - 168
SP - 4699
EP - 4704
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
IS - 5
ER -