title: Extracorporeal membrane oxygenation improves survival in a novel 24-hour pig model of severe acute respiratory distress syndrome.
abstract: Extracorporeal membrane oxygenation (ECMO) is increasingly being used to treat severe acute respiratory distress syndrome (ARDS). However, there is limited clinical evidence about how to optimize the technique. Experimental research can provide an alternative to fill the actual knowledge gap. The purpose of the present study was to develop and validate an animal model of acute lung injury (ALI) which resembled severe ARDS, and which could be successfully supported with ECMO. Eighteen pigs were randomly allocated into three groups: sham, ALI, and ALI + ECMO. ALI was induced by a double-hit consisting in repeated saline lavage followed by a 2-hour period of injurious ventilation. All animals were followed up to 24 hours while being ventilated with conventional ventilation (tidal volume 10 ml/kg). The lung injury model resulted in severe hypoxemia, increased airway pressures, pulmonary hypertension, and altered alveolar membrane barrier function, as indicated by an increased protein concentration in bronchoalveolar fluid, and increased wet/dry lung weight ratio. Histologic examination revealed severe diffuse alveolar damage, characteristic of ARDS. Veno-venous ECMO was started at the end of lung injury induction with a flow > 60 ml/kg/min resulting in rapid reversal of hypoxemia and pulmonary hypertension. Mortality was 0, 66.6 and 16.6% in the SHAM, ALI and ALI + ECMO groups, respectively (p < 0.05). This is a novel clinically relevant animal model that can be used to optimize the approach to ECMO and foster translational research in extracorporeal lung support.
authors.affiliation: Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile Santiago, Chile.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Araos
authors.affiliation: Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile Santiago, Chile.
authors.forename: Leyla
authors.initials: L
authors.lastname: Alegría
authors.affiliation: Carrera de Kinesiología, UDA Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile Santiago, Chile.
authors.forename: Patricio
authors.initials: P
authors.lastname: García
authors.affiliation: Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile Santiago, Chile.
authors.forename: Felipe
authors.initials: F
authors.lastname: Damiani
authors.affiliation: Unidad de Pacientes Críticos, Hospital La Florida Santiago, Chile.
authors.forename: Pablo
authors.initials: P
authors.lastname: Tapia
authors.affiliation: Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile Santiago, Chile.
authors.forename: Dagoberto
authors.initials: D
authors.lastname: Soto
authors.affiliation: Unidad de Cuidados Intensivos Pediátricos, Clinica Alemana Santiago, Chile.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Salomon
authors.affiliation: Centro de Pacientes Críticos, Hospital Clínico de Red de Salud UC CHRISTUS Santiago, Chile.
authors.forename: Felipe
authors.initials: F
authors.lastname: Rodriguez
authors.affiliation: Centro de Pacientes Críticos, Hospital Clínico de Red de Salud UC CHRISTUS Santiago, Chile.
authors.forename: Macarena
authors.initials: M
authors.lastname: Amthauer
authors.affiliation: Centro de Medicina Regenerativa, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo Santiago, Chile.
authors.forename: Benjamín
authors.initials: B
authors.lastname: Erranz
authors.affiliation: Centro de Pacientes Críticos, Hospital Clínico de Red de Salud UC CHRISTUS Santiago, Chile.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Castro
authors.affiliation: Unidad de Cuidados Intensivos Pediátricos, Hospital El Carmen, Dr. Luis Valentín Ferrada Santiago, Chile.
authors.forename: Pamela
authors.initials: P
authors.lastname: Carreño
authors.affiliation: Unidad de Cuidados Intensivos Pediátricos, Hospital El Carmen, Dr. Luis Valentín Ferrada Santiago, Chile.
authors.forename: Tania
authors.initials: T
authors.lastname: Medina
authors.affiliation: Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile Santiago, Chile.
authors.forename: Jaime
authors.initials: J
authors.lastname: Retamal
authors.affiliation: Unidad de Cuidados Intensivos Pediátricos, Hospital El Carmen, Dr. Luis Valentín FerradaSantiago, Chile; Centro de Investigación de Medicina Veterinaria, Escuela de Medicina Veterinaria, Facultad de Ecología y Recursos Naturales, Universidad Andres BelloSantiago, Chile.
authors.forename: Pablo
authors.initials: P
authors.lastname: Cruces
authors.affiliation: Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile Santiago, Chile.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Bugedo
authors.affiliation: Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile Santiago, Chile.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Bruhn
keywords: ARDS; ECMO; mechanical ventilation