Introduction
Extracorporeal membrane oxygenation (ECMO) is widely used for patients with compromised cardiopulmonary function. Whether different types of arterial cannular positioning have any effect on the kidney, when veno-arterial ECMO is applied to patients, is unclear. Therefore, we compare...
Introduction
Extracorporeal membrane oxygenation (ECMO) is widely used for patients with compromised cardiopulmonary function. Whether different types of arterial cannular positioning have any effect on the kidney, when veno-arterial ECMO is applied to patients, is unclear. Therefore, we compared hemodynamic differences and acute kidney injury biomarkers between central ECMO (cECMO) and peripheral ECMO (pECMO) by using swine to evaluate the effect of cannular positioning on the kidney.
Materials and Methods
A total of 12 swine were allocated randomly into two groups. Arterial cannula in the cECMO group were placed in the ascending aorta, and in the pECMO group, they were placed in the femoral artery. ECMO continued for 6 hours. Hemodynamic parameters such as mean arterial pressure (MAP), renal artery flow rate (MAF), energy equivalent pressure (EEP), and surplus hemodynamic energy (SHE) were measured at the left kidney artery. For evaluation of kidney injury, blood samples were obtained to measure levels of blood urea nitrogen (BUN), creatinine, cystatin C, and neutrophil gelatinase-associated lipocalin (NGAL). Blood samples were drawn at various times (before ECMO, and 1 hour, 3 hour, and 6 hours after initiating ECMO). The hemodynamic parameters, change ratio of hemodynamic parameters before and after ECMO, and serial changes in biomarkers were compared to determine the better arterial cannula position.
Results
Before the start of ECMO, no significant differences were observed between the two groups in terms of the hemodynamic parameters. For the change ratio before and after ECMO, the pECMO group showed a significantly higher increase in MAP (99.5%), MAF (213%), EEP (63%), and a greater decrease in SHE (18.1%) than did the cECMO group. In the inter-group analysis, no significantly different trends by time were observed between the two groups for BUN, creatinine, cystatin C, or NGAL levels.
Conclusion
In this study, we found that pECMO was associated with higher energy profile than cECMO. There was no evidence of kidney injury according to the mode of ECMO. Therefore, pECMO can be more favorable to the kidneys as compared to cECMO in hemodynamic aspects.
Introduction
Extracorporeal membrane oxygenation (ECMO) is widely used for patients with compromised cardiopulmonary function. Whether different types of arterial cannular positioning have any effect on the kidney, when veno-arterial ECMO is applied to patients, is unclear. Therefore, we compared hemodynamic differences and acute kidney injury biomarkers between central ECMO (cECMO) and peripheral ECMO (pECMO) by using swine to evaluate the effect of cannular positioning on the kidney.
Materials and Methods
A total of 12 swine were allocated randomly into two groups. Arterial cannula in the cECMO group were placed in the ascending aorta, and in the pECMO group, they were placed in the femoral artery. ECMO continued for 6 hours. Hemodynamic parameters such as mean arterial pressure (MAP), renal artery flow rate (MAF), energy equivalent pressure (EEP), and surplus hemodynamic energy (SHE) were measured at the left kidney artery. For evaluation of kidney injury, blood samples were obtained to measure levels of blood urea nitrogen (BUN), creatinine, cystatin C, and neutrophil gelatinase-associated lipocalin (NGAL). Blood samples were drawn at various times (before ECMO, and 1 hour, 3 hour, and 6 hours after initiating ECMO). The hemodynamic parameters, change ratio of hemodynamic parameters before and after ECMO, and serial changes in biomarkers were compared to determine the better arterial cannula position.
Results
Before the start of ECMO, no significant differences were observed between the two groups in terms of the hemodynamic parameters. For the change ratio before and after ECMO, the pECMO group showed a significantly higher increase in MAP (99.5%), MAF (213%), EEP (63%), and a greater decrease in SHE (18.1%) than did the cECMO group. In the inter-group analysis, no significantly different trends by time were observed between the two groups for BUN, creatinine, cystatin C, or NGAL levels.
Conclusion
In this study, we found that pECMO was associated with higher energy profile than cECMO. There was no evidence of kidney injury according to the mode of ECMO. Therefore, pECMO can be more favorable to the kidneys as compared to cECMO in hemodynamic aspects.
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