Immediate inflammatory response to mechanical circulatory support in a porcine model of severe cardiogenic shock

Emilie Gregers; Peter H Frederiksen; Nanna L J Udesen; Louise Linde; Ann Banke; Amalie L Povlsen; Jeppe P Larsen; Christian Hassager; Lisette O Jensen; Jens F Lassen; Henrik Schmidt; Hanne B Ravn; Peter M H Heegaard; Jacob E Møller

doi:10.1186/s40635-024-00625-8

Immediate inflammatory response to mechanical circulatory support in a porcine model of severe cardiogenic shock

Intensive Care Med Exp. 2024 Apr 22;12(1):39. doi: 10.1186/s40635-024-00625-8.

Authors

Affiliations

¹ Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen O, Denmark. Emilie.gregers@gmail.com.
² Department of Cardiology, Odense University Hospital, Odense, Denmark.
³ Department of Cardiothoracic Anesthesiology, Odense University Hospital, Odense, Denmark.
⁴ Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen O, Denmark.
⁵ Department of Health Technology, Technical University of Denmark, Lyngby, Denmark.

Abstract

Background: In selected cases of cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is combined with trans valvular micro axial flow pumps (ECMELLA). Observational studies indicate that ECMELLA may reduce mortality but exposing the patient to two advanced mechanical support devices may affect the early inflammatory response. We aimed to explore inflammatory biomarkers in a porcine cardiogenic shock model managed with V-A ECMO or ECMELLA.

Methods: Fourteen landrace pigs had acute myocardial infarction-induced cardiogenic shock with minimal arterial pulsatility by microsphere embolization and were afterwards managed 1:1 with either V-A ECMO or ECMELLA for 4 h. Serial blood samples were drawn hourly and analyzed for serum concentrations of interleukin 6 (IL-6), IL-8, tumor necrosis factor alpha, and serum amyloid A (SAA).

Results: An increase in IL-6, IL-8, and SAA levels was observed during the experiment for both groups. At 2-4 h of support, IL-6 levels were higher in ECMELLA compared to V-A ECMO animals (difference: 1416 pg/ml, 1278 pg/ml, and 1030 pg/ml). SAA levels were higher in ECMELLA animals after 3 and 4 h of support (difference: 401 ng/ml and 524 ng/ml) and a significant treatment-by-time effect of ECMELLA on SAA was identified (p = 0.04). No statistical significant between-group differences were observed in carotid artery blood flow, urine output, and lactate levels.

Conclusions: Left ventricular unloading with Impella during V-A ECMO resulted in a more extensive inflammatory reaction despite similar end-organ perfusion.

Keywords: Acute myocardial infarction; Cardiogenic shock; ECMELLA; ECMO; Unloading of the left ventricle; Venoarterial extracorporeal membrane oxygenation.