Establishment of prolonged veno-venous extracorporeal membrane oxygenation support model in large animals_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QI Jiachen ¹ , GAO Sizhe ¹ , LIU Gang ¹ , ZHANG Min ² , ZHANG Qiaoni ¹ , YAN Weidong ¹ , TENG Yuan ¹ , WANG Jian ¹ , YAN Shujie ¹ , ZHOU Chun ¹ , WANG Qian ¹ ,  JI Bingyang ¹

1. Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, P. R. China;
2. National Center for Cardiovascular Disease, Animal Experimental Center of Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing Key Laboratory of Pre-clinical Research and Evaluation for Cardiovascular Implant Materials, Beijing, 102300, P. R. China;

Corresponding author：

JI Bingyang, Email: jibingyang@fuwai.com

Keywords：

Extracorporeal membrane oxygenation; long-term support model; conscious sheep; dual lumen cannula

DOI：

10.7507/1007-4848.202012124

Video：

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Objective To explore the safety and feasibility of the establishment method and management strategy of prolonged support model with veno-venous extracorporeal membrane oxygenation (V-V ECMO) under dual lumen cannula (DLC) in conscious sheep.Methods Three adult male sheep were selected. An Avalon Elite DLC was inserted into the superior vena cava, right atrium, and inferior vena cava through the right jugular vein and was connected with centrifugal pump and oxygenator to establish the extracorporeal membrane oxygenation circuit. All the 3 sheep were transferred into the monitoring cage after operation and were ambulatory after anesthesia recovery. Hemodynamic parameters and extracorporeal membrane oxygenation performance were measured every day.Results All three sheep survived to the end of the experiment (7 days). In the whole process of the experiment, the basic vital signs of the experimental sheep were stable, and no serious bleeding or thrombotic events occurred. During the experiment, hemoglobin concentration and platelet count were relatively stable, plasma free hemoglobin was maintained at a low level, extracorporeal membrane oxygenation flow rate was stable, and oxygenation performance of oxygenator was good.Conclusion Prolonged V-V ECMO model in conscious sheep under DLC is feasible and stable.

Citation： QI Jiachen, GAO Sizhe, LIU Gang, ZHANG Min, ZHANG Qiaoni, YAN Weidong, TENG Yuan, WANG Jian, YAN Shujie, ZHOU Chun, WANG Qian, JI Bingyang. Establishment of prolonged veno-venous extracorporeal membrane oxygenation support model in large animals. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(9): 1166-1171. doi: 10.7507/1007-4848.202012124 Copy

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2.	Langer T, Santini A, Bottino N, et al. "Awake" extracorporeal membrane oxygenation (ECMO): Pathophysiology, technical considerations, and clinical pioneering. Crit Care, 2016, 20(1): 150.
3.	Fuehner T, Kuehn C, Hadem J, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med, 2012, 185(7): 763-768.
4.	Crotti S, Iotti GA, Lissoni A, et al. Organ allocation waiting time during extracorporeal bridge to lung transplant affects outcomes. Chest, 2013, 144(3): 1018-1025.
5.	Garcia JP, Kon ZN, Evans C, et al. Ambulatory veno-venous extracorporeal membrane oxygenation: Innovation and pitfalls. J Thorac Cardiovasc Surg, 2011, 142(4): 755-761.
6.	Crotti S, Lissoni A, Tubiolo D, et al. Artificial lung as an alternative to mechanical ventilation in COPD exacerbation. Eur Respir J, 2012, 39(1): 212-215.
7.	Wilhelmi MH, Tiede A, Teebken OE, et al. Ovine blood: Establishment of a list of reference values relevant for blood coagulation in sheep. ASAIO J, 2012, 58(1): 79-82.
8.	Zhou X, Wang D, Sumpter R, et al. Long-term support with an ambulatory percutaneous paracorporeal artificial lung. J Heart Lung Transplant, 2012, 31(6): 648-654.
9.	Garcia JP, Iacono A, Kon ZN, et al. Ambulatory extracorporeal membrane oxygenation: A new approach for bridge-to-lung transplantation. J Thorac Cardiovasc Surg, 2010, 139(6): e137-e139.
10.	Javidfar J, Brodie D, Wang D, et al. Use of bicaval dual-lumen catheter for adult venovenous extracorporeal membrane oxygenation. Ann Thorac Surg, 2011, 91(6): 1763-1768.
11.	Shekar K, Fung YL, Diab S, et al. Development of simulated and ovine models of extracorporeal life support to improve understanding of circuit-host interactions. Crit Care Resusc, 2012, 14(2): 105-111.
12.	Kocyildirim E, Cárdenes N, Ting A, et al. The use of GMP-produced bone marrow-derived stem cells in combination with extracorporeal membrane oxygenation in ARDS: An animal model. ASAIO J, 2017, 63(3): 324-332.
13.	Langer T, Vecchi V, Belenkiy SM, et al. Extracorporeal gas exchange and spontaneous breathing for the treatment of acute respiratory distress syndrome: An alternative to mechanical ventilation? Crit Care Med, 2014, 42(3): e211-e220.
14.	Karagiannidis C, Joost T, Strassmann S, et al. Safety and efficacy of a novel pneumatically driven extracorporeal membrane oxygenation device. Ann Thorac Surg, 2020, 109(6): 1684-1691.

1. Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med, 2018, 378(21): 1965-1975.
2. Langer T, Santini A, Bottino N, et al. "Awake" extracorporeal membrane oxygenation (ECMO): Pathophysiology, technical considerations, and clinical pioneering. Crit Care, 2016, 20(1): 150.
3. Fuehner T, Kuehn C, Hadem J, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med, 2012, 185(7): 763-768.
4. Crotti S, Iotti GA, Lissoni A, et al. Organ allocation waiting time during extracorporeal bridge to lung transplant affects outcomes. Chest, 2013, 144(3): 1018-1025.
5. Garcia JP, Kon ZN, Evans C, et al. Ambulatory veno-venous extracorporeal membrane oxygenation: Innovation and pitfalls. J Thorac Cardiovasc Surg, 2011, 142(4): 755-761.
6. Crotti S, Lissoni A, Tubiolo D, et al. Artificial lung as an alternative to mechanical ventilation in COPD exacerbation. Eur Respir J, 2012, 39(1): 212-215.
7. Wilhelmi MH, Tiede A, Teebken OE, et al. Ovine blood: Establishment of a list of reference values relevant for blood coagulation in sheep. ASAIO J, 2012, 58(1): 79-82.
8. Zhou X, Wang D, Sumpter R, et al. Long-term support with an ambulatory percutaneous paracorporeal artificial lung. J Heart Lung Transplant, 2012, 31(6): 648-654.
9. Garcia JP, Iacono A, Kon ZN, et al. Ambulatory extracorporeal membrane oxygenation: A new approach for bridge-to-lung transplantation. J Thorac Cardiovasc Surg, 2010, 139(6): e137-e139.
10. Javidfar J, Brodie D, Wang D, et al. Use of bicaval dual-lumen catheter for adult venovenous extracorporeal membrane oxygenation. Ann Thorac Surg, 2011, 91(6): 1763-1768.
11. Shekar K, Fung YL, Diab S, et al. Development of simulated and ovine models of extracorporeal life support to improve understanding of circuit-host interactions. Crit Care Resusc, 2012, 14(2): 105-111.
12. Kocyildirim E, Cárdenes N, Ting A, et al. The use of GMP-produced bone marrow-derived stem cells in combination with extracorporeal membrane oxygenation in ARDS: An animal model. ASAIO J, 2017, 63(3): 324-332.
13. Langer T, Vecchi V, Belenkiy SM, et al. Extracorporeal gas exchange and spontaneous breathing for the treatment of acute respiratory distress syndrome: An alternative to mechanical ventilation? Crit Care Med, 2014, 42(3): e211-e220.
14. Karagiannidis C, Joost T, Strassmann S, et al. Safety and efficacy of a novel pneumatically driven extracorporeal membrane oxygenation device. Ann Thorac Surg, 2020, 109(6): 1684-1691.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Establishment of prolonged veno-venous extracorporeal membrane oxygenation support model in large animals

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