Fluid Management in ECMO Therapy: Analysis of an Experimental Pig Model

Background: Fluid resuscitation is a necessary part of therapeutic measures to maintain sufficient hemodynamic in extracorporeal membrane oxygenation (ECMO) circulation. We aimed to investigate in a post-hoc analysis the impact of increased volume therapy during ECMO circulation on renal function and organ edema in a large animal model.

Method: ECMO therapy was performed in 12 female pigs (Deutsche Landrasse × Pietrain) for 10 hours. Application volume, in regard to necessary maintenance of hemodynamics, was divided into moderate in extensive volume therapy (MVT/EVT) due to the double quantity of calculated physiologic urine output for the planed study period. Respiratory and hemodynamic data were measured continuously. Additionally, renal function and organ edema were assessed by blood and tissue samples.

Results: Four pigs were included in MVT group and eight pigs were analyzed in EVT group. After 10 hours of ECMO circulation, no major differences were seen between the groups in regard of hemodynamic and respiratory data. Relative change of creatinine after 10 hours ECMO support was significantly higher in EVT (1.3 ± 0.3 MVT vs. 1.8 ± 0.5 EVT; p = 0.033). No major differences were evident for lung, heart, liver, and kidney samples in regard of the organ edema in comparison of EVT and MVT. Bowel tissue showed higher percentage of edema in EVT compared with MVT (77 ± 2% MVT vs. 80 ± 3% EVT; p = 0.049).

Conclusion: Presented data suggest potential deterioration of renal and intestinal mucosa function by increase in tissue edema due to administered volume overload during ECMO therapy.

Publication History

Article published online:
03 February 2022