Developing dual hemofiltration plus cardiopulmonary bypass in rodents

Dissociated Oxygen Consumption and Carbon Dioxide Production in the Post-Cardiac Arrest Rat: A Novel Metabolic Phenotype

BACKGROUND

The concept that resuscitation from cardiac arrest (CA) results in a metabolic injury is broadly accepted, yet patients never receive this diagnosis. We sought to find evidence of metabolic injuries after CA by measuring O2 consumption and CO2 production (VCO2) in a rodent model. In addition, we tested the effect of inspired 100% O2 on the metabolism.

METHODS AND RESULTS

Rats were anesthetized and randomized into 3 groups: resuscitation from 10-minute asphyxia with inhaled 100% O2 (CA-fraction of inspired O2 [FIO2] 1.0), with 30% O2 (CA-FIO2 0.3), and sham with 30% O2 (sham-FIO2 0.3). Animals were resuscitated with manual cardiopulmonary resuscitation. The volume of extracted O2 (VO2) and VCO2 were measured for a 2-hour period after resuscitation. The respiratory quotient (RQ) was RQ=VCO2/VO2. VCO2 was elevated in CA-FIO2 1.0 and CA-FIO2 0.3 when compared with sham-FIO2 0.3 in minutes 5 to 40 after resuscitation (CA-FIO2 1.0: 16.7±2.2, P<0.01; CA-FIO2 0.3: 17.4±1.4, P<0.01; versus sham-FIO2 0.3: 13.6±1.1 mL/kg per minute), and then returned to normal. VO2 in CA-FIO2 1.0 and CA-FIO2 0.3 increased gradually and was significantly higher than sham-FIO2 0.3 2 hours after resuscitation (CA-FIO2 1.0: 28.7±6.7, P<0.01; CA-FIO2 0.3: 24.4±2.3, P<0.01; versus sham-FIO2 0.3: 15.8±2.4 mL/kg per minute). The RQ of CA animals persistently decreased (CA-FIO2 1.0: 0.54±0.12 versus CA-FIO2 0.3: 0.68±0.05 versus sham-FIO2 0.3: 0.93±0.11, P<0.01 overall).

CONCLUSIONS

CA altered cellular metabolism resulting in increased VO2 with normal VCO2. Normal VCO2 suggests that the postresuscitation Krebs cycle is operating at a presumably healthy rate. Increased VO2 in the face of normal VCO2 suggests a significant alteration in O2 utilization in postresuscitation. Several RQ values fell well outside the normally cited range of 0.7 to 1.0. Higher FIO2 may increase VO2, leading to even lower RQ values.

The effects of early high-volume hemofiltration on prolonged cardiac arrest in rats with reperfusion by cardiopulmonary bypass: a randomized controlled animal study

Background

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). 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.

Methods

Sprague-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.

Results

All 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).

Conclusions

There 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 material

The online version of this article (doi:10.1186/s40635-016-0101-6) contains supplementary material, which is available to authorized users.