Extracorporeal life support in a porcine model of septic endotoxemia with acute pulmonary hypertension: an experimental study
Background: This study evaluated the effects of veno-arterial (V-A) and veno-venoarterial (V-VA) ECMO in a porcine model of septic endotoxemia-induced acute pulmonary arterial hypertension (PAH). Our hypotheses were as follows: (1) V-VA ECMO lowers pulmonary vascular resistance (PVR) by delivering o...
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| Main Authors: | , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
8 September 2025
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| In: |
Journal of Clinical Medicine
Year: 2025, Volume: 14, Issue: 17, Pages: 1-14 |
| ISSN: | 2077-0383 |
| DOI: | 10.3390/jcm14176342 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.3390/jcm14176342 Verlag, kostenfrei, Volltext: https://www.mdpi.com/2077-0383/14/17/6342 
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| Author Notes: | Stany Sandrio, Joerg Krebs, Tobias Spanier, Grietje Beck, Manfred Thiel and Peter Tobias Graf |
| Summary: | Background: This study evaluated the effects of veno-arterial (V-A) and veno-venoarterial (V-VA) ECMO in a porcine model of septic endotoxemia-induced acute pulmonary arterial hypertension (PAH). Our hypotheses were as follows: (1) V-VA ECMO lowers pulmonary vascular resistance (PVR) by delivering oxygenated blood to the pulmonary circulation, and (2) both V-A and V-VA ECMO improve perfusion to vital organs while simultaneously unloading the right ventricle (RV). Methods: Acute PAH was induced with Salmonella abortus equi lipopolysaccharide (LPS) in 34 pigs. Animals were randomized to either a control group without ECMO or to two groups receiving V-A or V-VA ECMO. Results: All animals developed PAH after one hour of LPS infusion: mean pulmonary artery pressure (PAP) increased significantly from 26 (24-30) mmHg to 40 (34-46) mmHg (p < 0.0001), and PVR increased from 314 (221-390) to 787 (549-1073) (p < 0.0001). Neither V-A nor V-VA ECMO significantly reduced PVR compared to controls. RV end-diastolic area increased in the control group [6.1 (4.3-8.6) cm vs. 8.5 (7.8-9.7) cm, p = 0.2], but not in the V-A [4.7 (3.3-7.6) cm] and V-VA [4.3 (2.5-8.3) cm] ECMO groups. Blood flow in the cranial mesenteric artery and celiac trunk did not differ significantly with or without ECMO. Conclusions: Elevating pulmonary artery oxygen tension through V-A or V-VA ECMO did not reduce PVR or PAP. However, both ECMO configurations effectively unloaded the RV and maintained perfusion to abdominal organs. |
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| Item Description: | Gesehen am 30.10.2025 |
| Physical Description: | Online Resource |
| ISSN: | 2077-0383 |
| DOI: | 10.3390/jcm14176342 |