Effect of flow change on brain injury during an experimental model of differential hypoxaemia in cardiogenic shock supported by extracorporeal membrane oxygenation

Sacha Rozencwajg*, Silver Heinsar, Karin Wildi, Jae-Seung Jung, Sebastiano Maria Colombo, Chiara Palmieri, Kei Sato, Carmen Ainola, Xiaomeng Wang, Gabriella Abbate, Noriko Sato, Wayne B. Dyer, Samantha Livingstone, Leticia Helms, Nicole Bartnikowski, Mahe Bouquet, Margaret R. Passmore, Kieran Hyslop, Bruno Vidal, Janice D. ReidDaniel McGuire, Emily S. Wilson, Indrek Ratsep, Roberto Lorusso, Matthieu Schmidt, Jacky Y. Suen, Gianluigi Li Bassi*, John F. Fraser

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Differential hypoxaemia (DH) is common in patients supported by femoral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and can cause cerebral hypoxaemia. To date, no models have studied the direct impact of flow on cerebral damage. We investigated the impact of V-A ECMO flow on brain injury in an ovine model of DH. After inducing severe cardiorespiratory failure and providing ECMO support, we randomised six sheep into two groups: low flow (LF) in which ECMO was set at 2.5 L min(-1) ensuring that the brain was entirely perfused by the native heart and lungs, and high flow (HF) in which ECMO was set at 4.5 L min(-1) ensuring that the brain was at least partially perfused by ECMO. We used invasive (oxygenation tension-PbTO2, and cerebral microdialysis) and non-invasive (near infrared spectroscopy-NIRS) neuromonitoring, and euthanised animals after five hours for histological analysis. Cerebral oxygenation was significantly improved in the HF group as shown by higher PbTO2 levels (+ 215% vs - 58%, p = 0.043) and NIRS (67 +/- 5% vs 49 +/- 4%, p = 0.003). The HF group showed significantly less severe brain injury than the LF group in terms of neuronal shrinkage, congestion and perivascular oedema (p < 0.0001). Cerebral microdialysis values in the LF group all reached the pathological thresholds, even though no statistical difference was found between the two groups. Differential hypoxaemia can lead to cerebral damage after only a few hours and mandates a thorough neuromonitoring of patients. An increase in ECMO flow was an effective strategy to reduce such damages.
Original languageEnglish
Article number4002
Number of pages11
JournalScientific Reports
Volume13
Issue number1
DOIs
Publication statusPublished - 10 Mar 2023

Keywords

  • NEUROLOGIC COMPLICATIONS
  • HYPEROXIA
  • HYPOXIA

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