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Kayumov M, Habimana R, Kim D, Obiweluozor FO, Jeong IS, Cho HJ. Extracorporeal circulation models in small animals: beyond the limits of preclinical research. Acute Crit Care 2023; 38:1-7. [PMID: 36935529 PMCID: PMC10030238 DOI: 10.4266/acc.2023.00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) use has remarkably increased in recent years. Although ECMO has become essential for patients with refractory cardiac and respiratory failure, extracorporeal circulation (ECC) is associated with significant complications. Small-animal models of ECC have been developed and widely used to better understand ECC-induced pathophysiology. This review article summarizes the development of small-animal ECC models, including the animal species, circuit configuration, priming, perioperative procedures, cannulation, and future perspectives of small-animal ECMO models.
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Affiliation(s)
- Mukhammad Kayumov
- Department of Medical Science, Chonnam National University Graduate School, Gwangju, Korea
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Hospital Medical School, Gwangju, Korea
- Extracorporeal Circulation Research Team, Chonnam National University Hospital, Gwangju, Korea
| | - Reverien Habimana
- Extracorporeal Circulation Research Team, Chonnam National University Hospital, Gwangju, Korea
- Department of Biomedical Sciences, Chonnam National University Graduate School, Chonnam National University Medical School, Gwangju, Korea
| | - Dowan Kim
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Hospital Medical School, Gwangju, Korea
- Extracorporeal Circulation Research Team, Chonnam National University Hospital, Gwangju, Korea
| | - Francis O Obiweluozor
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Hospital Medical School, Gwangju, Korea
- Extracorporeal Circulation Research Team, Chonnam National University Hospital, Gwangju, Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Hospital Medical School, Gwangju, Korea
- Extracorporeal Circulation Research Team, Chonnam National University Hospital, Gwangju, Korea
| | - Hwa Jin Cho
- Extracorporeal Circulation Research Team, Chonnam National University Hospital, Gwangju, Korea
- Department of Pediatrics, Chonnam National University Children's Hospital and Chonnam National University Medical School, Gwangju, Korea
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A Murine Model of Veno-Arterial Extracorporeal Membrane Oxygenation. ASAIO J 2022; 68:e243-e250. [PMID: 36229020 DOI: 10.1097/mat.0000000000001828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The mechanisms driving the pathologic state created by extracorporeal membrane oxygenation (ECMO) remain poorly defined. We developed the first complete blood-primed murine model of veno-arterial ECMO capable of maintaining oxygenation and perfusion, allowing molecular studies that are unavailable in larger animal models. Fifteen C57BL/6 mice underwent ECMO by cannulating the left common carotid artery and the right external jugular vein. The mean arterial pressure was measured through cannulation of the femoral artery. The blood-primed circuit functioned well. Hemodynamic parameters remained stable and blood gas analyses showed adequate oxygenation of the animals during ECMO over a 1-hour timeframe. A significant increase in plasma-free hemoglobin was observed following ECMO, likely secondary to hemolysis within the miniaturized circuit components. Paralleling clinical data, ECMO resulted in a significant increase in plasma levels of multiple proinflammatory cytokines as well as evidence of early signs of kidney and liver dysfunction. These results demonstrate that this novel, miniature blood-primed ECMO circuit represents a functional murine model of ECMO that will provide unique opportunities for further studies to expand our knowledge of ECMO-related pathologies using the wealth of available genetic, pharmacological, and biochemical murine reagents not available for other species.
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Sandeep B, Xiao Z, Zhao F, Feng Q, Gao K. Role of Platelets in Acute Lung Injury After Extracorporeal Circulation in Cardiac Surgery Patients: A Systemic Review. Curr Probl Cardiol 2022; 47:101088. [PMID: 34936908 DOI: 10.1016/j.cpcardiol.2021.101088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 11/15/2022]
Abstract
In vitro circulation (cardiopulmonary bypass, CPB) has been widely used in heart surgery. In the past, it was believed that the reduction of platelet count and impaired platelet function during cardiac surgery were the main causes of acute lung injury (ALI). ALI is a life-threatening clinical syndrome in critically ill patients due to an uncontrolled systemic inflammatory response resulting from direct injury to the lung or indirect injury in the setting of a systemic process. Platelets have an emerging and incompletely understood role in a myriad of ALI after extracorporeal circulation in cardiac surgery patients. An electronic literature search was performed using Pubmed, Scopus and Cinahl investigating ALI, pathogenesis, and role of platelets, treatment and management for ALI patients. Many studies have shown that in vitro circulation is a nonphysiological process that can lead to a decrease in the number of platelets and impaired platelet function, as well as varying degrees of lung damage. The relationship between the effects of in vitro circulation on platelets and acute lung injury is still controversial. This review article discusses the role of platelets in lung injury after cardiopulmonary bypass and resent development in the management of ALI.
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Affiliation(s)
- Bhushan Sandeep
- Department of Cardiothoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Zongwei Xiao
- Department of Cardiothoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Fengying Zhao
- Department of Intensive Care Unit, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Qianru Feng
- Department of Intensive Care Unit, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Ke Gao
- Department of Cardiothoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, China.
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Govender K, Cabrales P. Extracorporeal circulation impairs microcirculation perfusion and organ function. J Appl Physiol (1985) 2022; 132:794-810. [PMID: 35085033 PMCID: PMC8917920 DOI: 10.1152/japplphysiol.00726.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is a procedure used to aid respiratory function in critical patients, involving extracorporeal circulation (ECC) of blood. There is a limited number of studies quantifying the hemodynamic effects of ECC procedures on the microcirculation. We sought to mimic veno-arterial-ECMO flow conditions by use of a scaled-down circuit primed with either lactate Ringer (LR) or 5% human serum albumin (HSA). The circuit was first tested using benchtop runs with blood, and subsequently used for in vivo experiments in Golden Syrian hamsters instrumented with a dorsal window chamber to allow for quantification of microvascular hemodynamics and functional capillary density (FCD). Results showed significant impairment in FCD, and a reduction of arteriolar and venular blood flow, with HSA providing significant higher blood flows and FCD compared with LR. Changes in hematocrit and RBC labeling after ECC reflected a shift in plasma volume, which may stem from a loss in intravascular oncotic pressure due to priming fluids. The distribution of hemoglobin oxygen saturation in the microvasculature showed a significant decrease in venules after ECC. In addition, major organs such as the kidney and heart showed increases in both inflammatory and damage markers. These results suggest that ECC impairs microvasculature function and promotes ischemia and hypoxia in the tissues, which can be vital to understanding comorbid clinical outcomes from ECC procedures such as acute kidney injury and multiorgan dysfunction.NEW & NOTEWORTHY ECC reduces microvascular perfusion, with no full recovery 24 h after ECC. HSA performed better as compared with LR in terms of FCD and venule flow, as well as venule oxygen saturation. Increases in inflammatory and damage markers in key organs were observed within all organs analyzed.
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Affiliation(s)
- Krianthan Govender
- Functional Cardiovascular Engineering Laboratory, Bioengineering Department, University of California San Diego, La Jolla, California
| | - Pedro Cabrales
- Functional Cardiovascular Engineering Laboratory, Bioengineering Department, University of California San Diego, La Jolla, California
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Sandeep B, Xiao Z, Zhao F, Feng Q, Gao K. Role of Platelets in Acute Lung Injury After Extracorporeal Circulation in Cardiac Surgery Patients: A Systemic Review. Curr Probl Cardiol 2021. [DOI: https://doi.org/10.1016/j.cpcardiol.2021.101088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Traumatic injury pattern is of equal relevance as injury severity for experimental (poly)trauma modeling. Sci Rep 2019; 9:5706. [PMID: 30952899 PMCID: PMC6450898 DOI: 10.1038/s41598-019-42085-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 03/21/2019] [Indexed: 01/02/2023] Open
Abstract
This study aims to elaborate the relevance of trauma severity and traumatic injury pattern in different multiple and/or polytrauma models by comparing five singular trauma to two different polytrauma (PT) models with high and one multiple trauma (MT) model with low injury-severity score (ISS). The aim is to provide a baseline for reducing animal harm according to 3Rs by providing less injury as possible in polytrauma modeling. Mice were randomly assigned to 10 groups: controls (Ctrl; n = 15), Sham (n = 15); monotrauma groups: hemorrhagic shock (HS; n = 15), thoracic trauma (TxT; n = 18), osteotomy with external fixation (Fx; n = 16), bilateral soft tissue trauma (bSTT; n = 16) or laparotomy (Lap; n = 16); two PT groups: PT I (TxT + HS + Fx; ISS = 18; n = 18), PT II (TxT + HS + Fx + Lap; ISS = 22; n = 18), and a MT group (TxT + HS + bSTT + Lap, ISS = 13; n = 18). Activity and mortality were assessed. Blood gas analyses and organ damage markers were determined after 6 h. Significant mortality occurred in TxT, PT and MT (11.7%). Activity decreased significantly in TxT, HS, both polytrauma and MT vs. Ctrl/Sham. PT-groups and MT had significantly decreased activity vs. bsTT, Lap or Fx. MT had significantly lower pCO2vs. Ctrl/Sham, Lap or bsTT. Transaminases increased significantly in PT-groups and MT vs. Ctrl, Sham or monotrauma. Traumatic injury pattern is of comparable relevance as injury severity for experimental multiple or (poly)trauma modeling.
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Qiu Y, Chen C, Zhang J, Chen M, Gong H, Gong L, Du L, Wang R. VEGF attenuates lung injury by inducing homing of CD133+ progenitors via VEGFR1. Biochem Biophys Res Commun 2019; 511:650-657. [DOI: 10.1016/j.bbrc.2019.02.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/14/2019] [Indexed: 12/22/2022]
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Luo S, Wang Y, An Q, Chen H, Zhao J, Zhang J, Meng W, Du L. Platelets protect lung from injury induced by systemic inflammatory response. Sci Rep 2017; 7:42080. [PMID: 28155889 PMCID: PMC5290476 DOI: 10.1038/srep42080] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/04/2017] [Indexed: 02/05/2023] Open
Abstract
Systemic inflammatory responses can severely injure lungs, prompting efforts to explore how to attenuate such injury. Here we explored whether platelets can help attenuate lung injury in mice resulting from extracorporeal circulation (ECC)-induced systemic inflammatory responses. Mice were subjected to ECC for 30 min, then treated with phosphate-buffered saline, platelets, the GPIIb/IIIa inhibitor Tirofiban, or the combination of platelets and Tirofiban. Blood and lung tissues were harvested 60 min later, and lung injury and inflammatory status were assessed. As expected, ECC caused systemic inflammation and pulmonary dysfunction, and platelet transfusion resulted in significantly milder lung injury and higher lung function. It also led to greater numbers of circulating platelet-leukocyte aggregates and greater platelet accumulation in the lung. Platelet transfusion was associated with higher production of transforming growth factor-β and as well as lower levels of tumour necrosis factor-α and neutrophil elastase in plasma and lung. None of these platelet effects was observed in the presence of Tirofiban. Our results suggest that, at least under certain conditions, platelets can protect lung from injury induced by systemic inflammatory responses.
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Affiliation(s)
- Shuhua Luo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 China
| | - Yabo Wang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 China
| | - Qi An
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 China
| | - Hao Chen
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 China
| | - Junfei Zhao
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 China
| | - Jie Zhang
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 China
| | - Wentong Meng
- Laboratory of Stem Cell Biology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 China
| | - Lei Du
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 China
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