Influence of cannula positioning on brain injury during extracorporeal membrane oxygenation

Seong Cheol Jeong, Hee Jung Kim, Yeon Soo Shin, Jung Wook Han, Ju Yong Lim, Ho Sung Son

Research output: Contribution to journalArticle

Abstract

Background: In veno-arterial extracorporeal membrane oxygenation (V-A ECMO), a patient is cannulated using either an atrio-aortic technique (central type ECMO; cECMO) or a femoro-femoral technique (peripheral type ECMO; pECMO). The direction of the pump flow at the aortic arch is anterograde from the ascending aorta in cECMO and retrograde from the descending aorta in pECMO. Hemodynamic differences from the position of the cannulas may influence the brain differently. To evaluate the effect of ECMO cannula positioning on the brain, hemodynamic data and plasma biomarkers were collected. Methods: Eight pigs were randomly divided into the cECMO group (n=4) or pECMO group (n=4). ECMO was administered for 6 hours at a pump flow rate based on the mean flow of the ascending aorta. Mean arterial pressure (MAP), mean arterial flow (MAF), energy equivalent pressure (EEP), and surplus hemodynamic energy (SHE) were measured in the brachiocephalic artery every 30 minutes. During ECMO treatment, plasma was collected for analysis of interleukin-6 (IL-6), S100B, glial fibrillary acidic protein (GFAP), and neuron-specific enolase. The data were analyzed using the Mann-Whitney U tests, and repeated measures ANOVAs; significance was set at P<0.05. Results: MAP and EEP at 1 and at 3 hours, MAF at all measured times, and SHE at 1 hour and 6 hours were significantly higher in the pECMO group. There was no significant difference in the levels of brain injury biomarkers between cECMO and pECMO groups. Conclusions: The hemodynamic data showed that pECMO was superior to cECMO. Based on the biomarker data, neither pECMO nor cECMO for 6 hours caused evidence of brain injury.

Original languageEnglish
Pages (from-to)6184-6191
Number of pages8
JournalJournal of Thoracic Disease
Volume10
Issue number11
DOIs
Publication statusPublished - 2018 Nov 1

Fingerprint

Extracorporeal Membrane Oxygenation
Brain Injuries
Hemodynamics
Biomarkers
Thoracic Aorta
Aorta
Arterial Pressure
Pressure
Phosphopyruvate Hydratase
Glial Fibrillary Acidic Protein
Brain
Nonparametric Statistics
Thigh
Interleukin-6
Analysis of Variance
Swine
Arteries
Cannula

Keywords

  • Brain injury
  • Cannula
  • Extracorporeal membrane oxygenation (ECMO)
  • Hemodynamics

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Influence of cannula positioning on brain injury during extracorporeal membrane oxygenation. / Jeong, Seong Cheol; Kim, Hee Jung; Shin, Yeon Soo; Han, Jung Wook; Lim, Ju Yong; Son, Ho Sung.

In: Journal of Thoracic Disease, Vol. 10, No. 11, 01.11.2018, p. 6184-6191.

Research output: Contribution to journalArticle

Jeong, Seong Cheol ; Kim, Hee Jung ; Shin, Yeon Soo ; Han, Jung Wook ; Lim, Ju Yong ; Son, Ho Sung. / Influence of cannula positioning on brain injury during extracorporeal membrane oxygenation. In: Journal of Thoracic Disease. 2018 ; Vol. 10, No. 11. pp. 6184-6191.
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abstract = "Background: In veno-arterial extracorporeal membrane oxygenation (V-A ECMO), a patient is cannulated using either an atrio-aortic technique (central type ECMO; cECMO) or a femoro-femoral technique (peripheral type ECMO; pECMO). The direction of the pump flow at the aortic arch is anterograde from the ascending aorta in cECMO and retrograde from the descending aorta in pECMO. Hemodynamic differences from the position of the cannulas may influence the brain differently. To evaluate the effect of ECMO cannula positioning on the brain, hemodynamic data and plasma biomarkers were collected. Methods: Eight pigs were randomly divided into the cECMO group (n=4) or pECMO group (n=4). ECMO was administered for 6 hours at a pump flow rate based on the mean flow of the ascending aorta. Mean arterial pressure (MAP), mean arterial flow (MAF), energy equivalent pressure (EEP), and surplus hemodynamic energy (SHE) were measured in the brachiocephalic artery every 30 minutes. During ECMO treatment, plasma was collected for analysis of interleukin-6 (IL-6), S100B, glial fibrillary acidic protein (GFAP), and neuron-specific enolase. The data were analyzed using the Mann-Whitney U tests, and repeated measures ANOVAs; significance was set at P<0.05. Results: MAP and EEP at 1 and at 3 hours, MAF at all measured times, and SHE at 1 hour and 6 hours were significantly higher in the pECMO group. There was no significant difference in the levels of brain injury biomarkers between cECMO and pECMO groups. Conclusions: The hemodynamic data showed that pECMO was superior to cECMO. Based on the biomarker data, neither pECMO nor cECMO for 6 hours caused evidence of brain injury.",
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T1 - Influence of cannula positioning on brain injury during extracorporeal membrane oxygenation

AU - Jeong, Seong Cheol

AU - Kim, Hee Jung

AU - Shin, Yeon Soo

AU - Han, Jung Wook

AU - Lim, Ju Yong

AU - Son, Ho Sung

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AB - Background: In veno-arterial extracorporeal membrane oxygenation (V-A ECMO), a patient is cannulated using either an atrio-aortic technique (central type ECMO; cECMO) or a femoro-femoral technique (peripheral type ECMO; pECMO). The direction of the pump flow at the aortic arch is anterograde from the ascending aorta in cECMO and retrograde from the descending aorta in pECMO. Hemodynamic differences from the position of the cannulas may influence the brain differently. To evaluate the effect of ECMO cannula positioning on the brain, hemodynamic data and plasma biomarkers were collected. Methods: Eight pigs were randomly divided into the cECMO group (n=4) or pECMO group (n=4). ECMO was administered for 6 hours at a pump flow rate based on the mean flow of the ascending aorta. Mean arterial pressure (MAP), mean arterial flow (MAF), energy equivalent pressure (EEP), and surplus hemodynamic energy (SHE) were measured in the brachiocephalic artery every 30 minutes. During ECMO treatment, plasma was collected for analysis of interleukin-6 (IL-6), S100B, glial fibrillary acidic protein (GFAP), and neuron-specific enolase. The data were analyzed using the Mann-Whitney U tests, and repeated measures ANOVAs; significance was set at P<0.05. Results: MAP and EEP at 1 and at 3 hours, MAF at all measured times, and SHE at 1 hour and 6 hours were significantly higher in the pECMO group. There was no significant difference in the levels of brain injury biomarkers between cECMO and pECMO groups. Conclusions: The hemodynamic data showed that pECMO was superior to cECMO. Based on the biomarker data, neither pECMO nor cECMO for 6 hours caused evidence of brain injury.

KW - Brain injury

KW - Cannula

KW - Extracorporeal membrane oxygenation (ECMO)

KW - Hemodynamics

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