Extracorporeal Membrane Oxygenation Improving Survival and Alleviating Kidney Injury in a Swine Model of Cardiac Arrest Compared to Conventional Cardiopulmonary Resuscitation  

作　　者：Xiao-Li Yuan Chun-Sheng Li Yun Zhang Ji-Yang Ling Qiang Zhang Yong Liang Bo Liu Lian-Xing Zhao Xiao-Li Yuan;Chun-Sheng Li;Yun Zhang;Ji-Yang Ling;Qiang Zhang;Yong Liang;Bo Liu;Lian-Xing Zhao(Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China)

机构地区：Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation,Department of Emergency Medicine,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China

出　　处：《Chinese Medical Journal》2018年第15期1840-1848,共9页中华医学杂志（英文版）

基　　金：The study was supported by me National Natural Science Foundation of China （No. 81372025） and the 2015 Annual Special Cultivation and Development Project for the Technology Innovation Base of the Beijing Key Laboratory Cardiopulmonary Cerebral Resuscitation （No.Z 151100001615056）.

摘　　要：Background： Acute kidney injury （AKI） frequently occurs in cardiopulmonary resuscitation patients. Studies comparing the effects of extracorporeal membrane oxygenation （ECMO） with conventional cardiopuhnonary resuscitation （CCPR） on AKI were rare. This study aimed to compare the effects of ECMO with those of CCPR on survival rate and AKI and explore the underlying mechanisms in a swine model of cardiac arrest （CA）. Methods： Sixteen male pigs were treated with ventricular fibrillation to establish CA model and then underwent CCPR （CCPR group, n = 8） or ECMO during cardiopulmonary resuscitation （ECPR group, n = 8）. The study endpoints were 6 h after return of spontaneous circulation （ROSC） or death. Serum and urine samples were collected at baseline and during the 6 h after ROSC. The biomarkers of AKI were detected by enzyme-linked immunosorbent assay. The apoptosis of renal tubular epithelial cells was discovered by transmission electron microscope （TEM） and terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Apoptosis-related genes were detected by immune-staining and Western blotting. Data were compared by Student＇s t-test. Results： All pigs in ECPR group were successfully resuscitated with a higher 6-h survival rate （8/8） compared to CCPR group （6/8）. The expressions ofAKl biomarkers including neutrophil gelatinase-associated lipocalin （NGAL）, tissue inhibitor ofmetalloproteinase2 （TIMP2）, insulin-like growth factor-binding protein 7 （IGFBP7）, liver fatty acid-binding protein （LFABP）, and kidney injury molecule l （Kim-1） were all increased along with the time after ROSC in both groups and lower in ECPR group compared with CCPR group. Especially, products of urinary T1MP and IGFBP levels （TIMP＊IGFBP） were significantly lower at ROSC4 （0.58 ± 0.10 ng^2/ml^2 vs. 1.18 ± 0.38 ng^2/ml^2, t = 4.33, P =0.003） and ROSC6 （1.79 ±0.45 ng2^/ml^2 vs. 3.00 ±0.44 ng^2/ml^2, t = 5.49, P 〈 0.001）; urinary LFABP was significantBackground： Acute kidney injury （AKI） frequently occurs in cardiopulmonary resuscitation patients. Studies comparing the effects of extracorporeal membrane oxygenation （ECMO） with conventional cardiopuhnonary resuscitation （CCPR） on AKI were rare. This study aimed to compare the effects of ECMO with those of CCPR on survival rate and AKI and explore the underlying mechanisms in a swine model of cardiac arrest （CA）. Methods： Sixteen male pigs were treated with ventricular fibrillation to establish CA model and then underwent CCPR （CCPR group, n = 8） or ECMO during cardiopulmonary resuscitation （ECPR group, n = 8）. The study endpoints were 6 h after return of spontaneous circulation （ROSC） or death. Serum and urine samples were collected at baseline and during the 6 h after ROSC. The biomarkers of AKI were detected by enzyme-linked immunosorbent assay. The apoptosis of renal tubular epithelial cells was discovered by transmission electron microscope （TEM） and terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Apoptosis-related genes were detected by immune-staining and Western blotting. Data were compared by Student＇s t-test. Results： All pigs in ECPR group were successfully resuscitated with a higher 6-h survival rate （8/8） compared to CCPR group （6/8）. The expressions ofAKl biomarkers including neutrophil gelatinase-associated lipocalin （NGAL）, tissue inhibitor ofmetalloproteinase2 （TIMP2）, insulin-like growth factor-binding protein 7 （IGFBP7）, liver fatty acid-binding protein （LFABP）, and kidney injury molecule l （Kim-1） were all increased along with the time after ROSC in both groups and lower in ECPR group compared with CCPR group. Especially, products of urinary T1MP and IGFBP levels （TIMP＊IGFBP） were significantly lower at ROSC4 （0.58 ± 0.10 ng^2/ml^2 vs. 1.18 ± 0.38 ng^2/ml^2, t = 4.33, P =0.003） and ROSC6 （1.79 ±0.45 ng2^/ml^2 vs. 3.00 ±0.44 ng^2/ml^2, t = 5.49, P 〈 0.001）; urinary LFABP was significant

关 键 词：Acute Kidney Injury Cardiac Arrest Cardiopulmonary Resuscitation： Extracorporeal Membrane Oxygenation： Swine 

分 类 号：Q463[生物学—生理学] X838[环境科学与工程—环境工程]