Protective effect of extracorporeal membrane pulmonary oxygenation combined with cardiopulmonary resuscitation on post-resuscitation lung injury

doi:10.5847/wjem.j.1920-8642.2021.04.009

Abstract

Abstract:

BACKGROUND: Cardiac arrest (CA) is a critical condition that is a concern to healthcare workers. Comparative studies on extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) technologies have shown that ECPR is superior to CCPR. However, there is a lack of studies that compare the protective effects of these two resuscitative methods on organs. Therefore, we aim to perform experiments in swine models of ventricular fibrillation-induced CA to study whether the early application of ECPR has advantages over CCPR in the lung injury and to explore the protective mechanism of ECPR on the post-resuscitation pulmonary injury.
METHODS: Sixteen male swine were randomized to CCPR (CCPR; n=8; CCPR alone) and ECPR (ECPR; n=8; extracorporeal membrane oxygenation with CCPR) groups, with the restoration of spontaneous circulation at 6 hours as an endpoint.
RESULTS: For the two groups, the survival rates between the two groups were not statistically significant (P>0.05), the blood and lung biomarkers were statistically significant (P<0.05), and the extravascular lung water and pulmonary vascular permeability index were statistically significant (P<0.01). Compared with the ECPR group, electron microscopy revealed mostly vacuolated intracellular alveolar type II lamellar bodies and a fuzzy lamellar structure with widening and blurring of the blood-gas barrier in the CCPR group.
CONCLUSIONS: ECPR may have pulmonary protective effects, possibly related to the regulation of alveolar surface-active proteins and mitigated oxidative stress response post-resuscitation.

Key words: Cardiac arrest, Swine, Alveolar surface-active protein, Oxidative stress injury, Pulmonary edema

Ji-yang Ling, Chun-sheng Li, Yun Zhang, Xiao-li Yuan, Bo Liu, Yong Liang, Qiang Zhang. Protective effect of extracorporeal membrane pulmonary oxygenation combined with cardiopulmonary resuscitation on post-resuscitation lung injury[J]. World Journal of Emergency Medicine, 2021, 12(4): 303-308.

Figures/Tables 3

References 33

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Variables	Baseline	ROSC6h	P-value
EVLW (mL/kg)
CCPR group	9.61±1.37	21.85±3.92	<0.001
ECPR group	9.39±1.70	11.78±1.82^*	0.017
PVPI
CCPR group	2.24±0.50	5.97±1.39	0.001
ECPR group	2.15±0.43	2.06±0.91^*	0.812

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