Resuscitation With ECMO Combined Ultrafiltration For Severe Hemorrhagic Shock Significantly Alleviating Kidney Injury In Rabbit

Background and objective: severe and uncontrolled hemorrhagic shock is the leadingcause of death after trauma and management of such problem is always a hard stuff forsurgeon. Traditionally, early fluid resuscitation can quickly restore blood pressure andtissue perfusion, but it can dilute the blood clotting factors, reduce blood viscosity, shiftingthe blood clot, increase the occurrence of hemorrhage and thromboembolism, and the effectof treatment of acute renal insufficiency is still not good. Extracorporeal membraneoxygenation (ECMO) is a Life support technology on the extension and expansion ofcardiopulmonary bypass (CPB).Owing to its powerful replacing function ofcardiopulmonary, critical rescue success rate rise significantly. Especially in patients withseriously damaged cardiopulmonary function, ECMO support sufficient rest to heart andlung and buy time for the subsequently treatment. Combined ultrafiltration technology canconcentrate blood, eliminate oxygen free radicals, inflammatory mediator and surplus waterin the blood, improve the colloid osmotic pressure of plasma, reduce the edema in tissuespace and restore the fluid balance and decrease the complications caused by hemodynamic.In this study, New Zealand White Rabbit was employed to establish the animal model ofpressure control serious hemorrhagic shock, ECMO combined ultrafiltration techniqueresuscitation and fluid resuscitation was took respectively to evaluate the different effectand elaborate the advantages and significance in kidney protection of ECMO.Method:(1)We choose24New Zealand White Rabbit(n=24), establish the pressure controlhemorrhagic shock animal model and maintain the shock state for3hours and mean arterialpressure in the range of35-40mmHg. Divide them into3groups as follows:1)unresuscitation,n1=8;2)ECMO combined ultrafiltration technique resuscitation(n2=8); 3)fluid resuscitation (n3=8).We record the heart rate via electrocardiograph monitoring andarterial pressure via fermoral artery catheter.(2)Observe the mean arterial pressure of each groups experimental rabbits afterresuscitation.Blood samples were collected before shock, in shock and after shock,examined the serum creatine(Scr), Interleukin-6(IL-6), Tumor necrosis factor-α(TNF-α) andLactic acid, and analyzed the results with one-way analysis of variance(ANOVA).(3)Kidney samples were collected and used for paraffin section:1) Hematoxylin-eosin(HE) staining, compare the different histopathological change of kidney tissues betweengroups；2) immunohistochemical staining, compare the different expression level of heatshock protein-70(HSP-70) between groups.Result:(1) Compare the mean arterial pressure of three groups after resuscitation,compared with unresuscitation group, fluid resuscitation group rised significantly(P<0.05).Compared with fluid resuscitation group and unresuscitation group, ECMO combinedultrafiltration technique resuscitation group rised significantly(P<0.05)；(2)The Scr level increased after hemorrhagic shock (P<0.05). Compared withunresuscitation group, the Scr level of resuscitation groups decreased significantly (P<0.05).Compared with fluid resuscitation group, the Scr level of ECMO combined ultrafiltrationtechnique resuscitation group decreased significantly (P<0.05), it suggest that ECMOcombined ultrafiltration technique has a better efficacy in alleviating the decrease of renalfunction when compared with fluid resuscitation. It can remove the inflammation factor inthe blood, reduce the incidence of inflammation and reduce the damage of kidney tissueThe level of IL-6、TNF and Lactic acid appear the same trend；(3)HE staining results indicated that the degree of kidney tissue necrosis andinflammatory of cytokine infiltration in ECMO combined ultrafiltration group alleviatednotably, compared with fluid resuscitation group.it suggest that ECMO combinedultrafiltration alleviate kidney tissues more effective compared with fluid resuscitation.Effect of fluid resuscitation is not obvious for alleviate the injury of kidney；(4)The expression level of HSP-70in the ECMO combined ultrafiltration group kidneytissue decreased notably, compared with fluid resuscitation group. it suggest that ECMOcombined ultrafiltration alleviate kidney tissues injury in acute stress reaction moreeffective compared with fluid resuscitation. Conclusion: ECMO combined ultrafiltration technique has the advantage in theresuscitation of serious hemorrhagic shock compared with conventional fluid resuscitation,it alleviate kidney tissues injury, ECMO make the tissues and organs get goodperfusion.ECMO combined ultrafiltration technique can Reduce the inflammation factorsand oxygen free radicals in the blood, the inflammatory response and Oxygen free radicaldamage in kidney tissue was deceased.