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The Perinatal Asphyxiated Lamb Model: A Model for Newborn Resuscitation
Published on: August 15, 2018
Extracorporeal membrane oxygenation induced cardiac dysfunction in newborn lambs
Lee A Pyles1, Robert A Gustafson, James Fortney
1Department of Pediatrics, University of Minnesota Amplatz Children's Hospital, 420 Delaware St., Minneapolis, MN 55455, USA. pyles001@umn.edu
Journal of Cardiovascular Translational Research
|September 18, 2010
Summary
Extracorporeal membrane oxygenation (ECMO) immediately reduces cardiac function in newborn lambs, even with reduced afterload. This early cardiac dysfunction suggests a potential negative impact on patients requiring ECMO for heart support.
Area of Science:
- Cardiovascular Physiology
- Pediatric Critical Care Medicine
- Extracorporeal Life Support
Background:
- Extracorporeal membrane oxygenation (ECMO) is vital for cardiopulmonary failure in neonates and children.
- Suboptimal outcomes in primary cardiac support via ECMO necessitate investigating its direct cardiac impact.
- Previous studies have not fully elucidated the immediate effects of ECMO initiation on cardiac function.
Purpose of the Study:
- To investigate the hypothesis that ECMO induces cardiac dysfunction in newborn lambs.
- To assess the immediate impact of ECMO initiation on left ventricular (LV) function.
- To differentiate between mechanical and humoral effects of ECMO on the heart.
Main Methods:
- Newborn lambs (4-7 days old) underwent a brief 5-minute ECMO trial at a flow rate of 100 ml/kg.
- Echocardiographic parameters (mVCFc, shortening fraction, peak systolic wall stress) and hemodynamic measurements (LV dp/dt max, LV dp/dt min) were recorded at baseline and post-ECMO.
- Cardiac function was assessed after initial short ECMO exposure, a brief disconnect, and a subsequent 1-hour ECMO period.
Main Results:
- Left ventricular (LV) velocity of circumferential fiber shortening corrected for heart rate (mVCFc) significantly decreased post-ECMO, despite reduced LV peak systolic wall stress.
- Hemodynamic measurements showed a significant decrease in LV maximum rate of pressure change with time (LV dp/dt max) and altered LV diastolic function (LV dp/dt min).
- An immediate decrement in LV function was observed upon ECMO initiation, independent of prolonged extracorporeal circuit exposure.
Conclusions:
- Short-term ECMO initiation causes immediate left ventricular dysfunction in newborn lambs, even with afterload reduction.
- This early cardiac dysfunction, confirmed by both echocardiographic and hemodynamic measures, may be an outcome-limiting factor for patients needing cardiac ECMO support.
- Further research is crucial to understand and mitigate the detrimental effects of ECMO initiation on cardiac function.