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      Extracorporeal circulation models in small animals: beyond the limits of preclinical research

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          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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          Extracorporeal membrane oxygenation for critically ill adults.

          Ralph Tramm, Dragan Ilic, Andrew Davies … (2015)
          Extracorporeal membrane oxygenation (ECMO) is a form of life support that targets the heart and lungs. Extracorporeal membrane oxygenation for severe respiratory failure accesses and returns blood from the venous system and provides non-pulmonary gas exchange. Extracorporeal membrane oxygenation for severe cardiac failure or for refractory cardiac arrest (extracorporeal cardiopulmonary resuscitation (ECPR)) provides gas exchange and systemic circulation. The configuration of ECMO is variable, and several pump-driven and pump-free systems are in use. Use of ECMO is associated with several risks. Patient-related adverse events include haemorrhage or extremity ischaemia; circuit-related adverse effects may include pump failure, oxygenator failure and thrombus formation. Use of ECMO in newborns and infants is well established, yet its clinical effectiveness in adults remains uncertain.
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            Insufflation of hydrogen gas restrains the inflammatory response of cardiopulmonary bypass in a rat model.

            Yutaka Fujii, Yoshiyuki Taenaka, Hirotsugu Tsuchimochi … (2013)
            Systemic inflammatory responses in patients receiving cardiac surgery with the use of the cardiopulmonary bypass (CPB) significantly contribute to CPB-associated morbidity and mortality. We hypothesized that insufflated hydrogen gas (H₂) would provide systemic anti-inflammatory and anti-apoptotic effects during CPB, therefore reducing proinflammatory cytokine levels. In this study, we examined the protective effect of H₂ on a rat CPB model. Rats were divided into three groups: the sham operation (SHAM) group, received sternotomy only; the CPB group, which was initiated and maintained for 60 min; and the CPB + H₂ group in which H₂ was given via an oxygenator during CPB for 60 min. We collected blood samples before, 20 min, and 60 min after the initiation of CPB. We measured the serum cytokine levels of (tumor necrosis factor-α, interleukin-6, and interleukin-10) and biochemical markers (lactate dehydrogenase, aspartate aminotransferase, and alanine aminotransferase). We also measured the wet-to-dry weight (W/D) ratio of the left lung 60 min after the initiation of CPB. In the CPB group, the cytokine and biochemical marker levels significantly increased 20 min after the CPB initiation and further increased 60 min after the CPB initiation as compared with the SHAM group. In the CPB + H₂ group, however, such increases were significantly suppressed at 60 min after the CPB initiation. Although the W/D ratio in the CPB group significantly increased as compared with that in the SHAM group, such an increase was also suppressed significantly in the CPB + H₂ group. We suggest that H₂ insufflation is a possible new potential therapy for counteracting CPB-induced systemic inflammation. © 2012, Copyright the Authors. Artificial Organs © 2012, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
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              Miniaturization of mechanical circulatory support systems.

              Thomas J Lee, Guruprasad A. Giridharan, Mark S Slaughter … (2012)
              Heart failure (HF) is increasing worldwide and represents a major burden in terms of health care resources and costs. Despite advances in medical care, prognosis with HF remains poor, especially in advanced stages. The large patient population with advanced HF and the limited number of donor organs stimulated the development of mechanical circulatory support (MCS) devices as a bridge to transplant and for destination therapy. However, MCS devices require a major operative intervention, cardiopulmonary bypass, and blood component exposure, which have been associated with significant adverse event rates, and long recovery periods. Miniaturization of MCS devices and the development of an efficient and reliable transcutaneous energy transfer system may provide the vehicle to overcome these limitations and usher in a new clinical paradigm in heart failure therapy by enabling less invasive beating heart surgical procedures for implantation, reduce cost, and improve patient outcomes and quality of life. Further, it is anticipated that future ventricular assist device technology will allow for a much wider application of the therapy in the treatment of heart failure including its use for myocardial recovery and as a platform for support for cell therapy in addition to permanent long-term support.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Acute Crit Care
                Journal ID (iso-abbrev): Acute Crit Care
                Journal ID (publisher-id): ACC
                Title: Acute and Critical Care
                Publisher: Korean Society of Critical Care Medicine
                ISSN (Print): 2586-6052
                ISSN (Electronic): 2586-6060
                Publication date (Print): February 2023
                Publication date (Electronic): 28 February 2023
                Volume: 38
                Issue: 1
                Pages: 1-7
                Affiliations
                [1 ]Department of Medical Science, Chonnam National University Graduate School, Gwangju, Korea
                [2 ]Department of Thoracic and Cardiovascular Surgery, Chonnam National University, Chonnam National University Hospital Medical School, Gwangju, Korea
                [3 ]Extracorporeal Circulation Research Team, Chonnam National University Hospital, Gwangju, Korea
                [4 ]Department of Biomedical Sciences, Chonnam National University Graduate School, Chonnam National University Medical School, Gwangju, Korea
                [5 ]Department of Pediatrics, Chonnam National University Children’s Hospital, Chonnam National University Medical School, Gwangju, Korea
                Author notes
                Corresponding author: Hwa Jin Cho Department of Pediatrics, Chonnam National University Children’s Hospital, Chonnam National University Medical School and Extracorporeal Circulation Research Team, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-6646, Fax: +82-62-222-6103, Email: chhj98@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-5533-3270
                http://orcid.org/0000-0001-5324-6045
                http://orcid.org/0000-0003-2262-2882
                http://orcid.org/0000-0002-1542-9542
                http://orcid.org/0000-0002-2249-0667
                http://orcid.org/0000-0002-2458-8529
                Article
                Publisher ID: acc-2023-00381
                DOI: 10.4266/acc.2023.00381
                PMC ID: 10030238
                PubMed ID: 36935529
                SO-VID: c7c6fac9-7e99-48d3-a2d0-926513269c82
                Copyright © Copyright © 2023 The Korean Society of Critical Care Medicine
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 9 February 2023
                Date revision received : 23 February 2023
                Date accepted : 24 February 2023
                Categories
                Subject: Review Article
                Subject: Basic Science and Research

                Keywords: cardiopulmonary bypass,extracorporeal circulation,extracorporeal membrane oxygenation,experimental research,review
                Data availability:
                Keywords: cardiopulmonary bypass, extracorporeal circulation, extracorporeal membrane oxygenation, experimental research, review

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