Intestinal Conditioning After Cardiac Arrest: The Use of Normothermic Extracorporeal Membrane Oxygenation in the Non-Heart-Beating Animal Model.
The effect of normothermic extracorporeal membrane oxygenation (NECMO) on small bowel preservation in a clinically relevant large animal model of expected donation after cardiac death (eDCD) was evaluated. Thirty domestic crossbred donor pigs were divided into five groups. The first group served as the live donation (LD) group, the second group served as the donation after cardiac death (DCD) group, and the remaining were further assigned into three subgroups: E1 group (1 h NECMO support), E3 group (3 h NECMO support), and E5 group (5 h NECMO support). Pathology, electron microscopy, energy metabolism, cell apoptosis, and tight junction (TJ) protein expression level of intestinal mucosa and the level of plasma d-lactic acid were evaluated in normal, cardiac death and at the end of extracorporeal support, respectively. The mean arterial pressure and PaO2 were maintained over 60 and 267 mm Hg during NECMO support, respectively. One hour of extracorporeal support could improve the energy status in intestines of the DCD group. Although the histologic damage and apoptosis of the E1 group had no significant difference with those of the LD and DCD groups (P > 0.05), the levels of intestinal mucosa TJ protein decreased (P < 0.05), and plasma d-lactic acid increased progressively (P < 0.05). With the extension of extracorporeal support, the degree of intestinal mucosa damage and intestinal permeability gradually increased, as well as the content of adenosine triphosphate in intestinal mucosa. The normothermic extracorporeal support for 1 h in DCD is beneficial for improving the energy status and viability of the bowel. However, the integrity of intestinal mucosa was destroyed gradually as extracorporeal support time went by. And the activation of intestinal epithelial apoptosis and hyperoxia might be the factors that lead to intestinal mucosa injury.
Department of Laparoscopic Surgery Center, Linyi People's Hospital, Shandong University, Linyi.
Mingxiao
M
Guo
Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing.
Danhua
D
Yao
Department of Surgery, Linyi Mental Health Center, Linyi, China.
Linlin
L
Li
Department of Laparoscopic Surgery Center, Linyi People's Hospital, Shandong University, Linyi.
Chunlei
C
Lu
Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing.
Yousheng
Y
Li
Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing.
Jieshou
J
Li
D000255:Adenosine Triphosphate / Q000032:analysis; D000818:Animals; D017209:Apoptosis; D001831:Body Temperature; D004195:Disease Models, Animal; D004734:Energy Metabolism; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000378:metabolism / Q000473:pathology* / Q000628:therapy*; D007422:Intestines / Q000473:pathology*; D019344:Lactic Acid / Q000097:blood; D008297:Male; D062793:Occludin / Q000032:analysis; D013552:Swine; D062826:Zonula Occludens-1 Protein / Q000032:analysis
D062793:Occludin; D062826:Zonula Occludens-1 Protein; D019344:Lactic Acid; D000255:Adenosine Triphosphate
Donation after cardiac death-Extracorporeal membrane oxygenation-Normothermic-Small bowel preservation-Animal model-Intestinal transplantation