ABSTRACT
BACKGROUND: Acute renal failure following heart failure assisted circulation have been extensively reported. However, little data have been available concerning morphological analysis of kidney tissues under that condition.OBJECTIVE: To observe morphological change of ischemia/reperfusion kidney in a sheep pulsatile catheter (PUCA) pump short-term support for heart failure model and explore causes of acute renal failure in assisted circulation patients.DESIGN, TIME AND SETTING: Self-contrast animal experiment was performed at the laboratory of Department of Cardiothoracic Surgery, Renji Hospital of Shanghai Second Medical University between July 2003 and April 2004.MATERIALS: PUCA pump was provided by Gerhard Rakhorst, Professor of Biomedical Engineering, University of Groningen.METHODS: After ischemic heart failure in 10 sheep was induced successfully and subsequently ischemia/reperfusion kidney was developed, PUCA pump was activated to support the hemodynamics for 3 hours.MAIN OUTCOME MEASURES: Hemodynamic parameters were monitored and recorded before thoracotomy, heart failure, and every 45 minutes after the support. Kidney biopsy specimens for light and electron microscopy were obtained 3 hours after support.RESULTS: PUCA pump support was successful in 7 of 10 sheep for 3 hours. During support with the PUCA pump,Hemodynamic parameters gradually restored to normal and stable condition, and blood pressure was close to baseline at the end of experiment. On both light and electron microscopy examination, mild acute kidney change was observed after ischemia/reperfusion. Cytosis in renal glomerulus associated with vasodilatation hyperemia, endepidermis in renal tubules hydropic degeneration, vasodilatation hyperemia and Interstitial edema in renal medulla were the main findings.CONCLUSION: PUCA pump could successfully maintain the hemodynamics for 3 hours in a sheep acute heart failure model,but pathological change in ischemia/reperfusion kidney was remained. It is impossible to predict prognosis of renal function on hemodynamic data alone during support.
ABSTRACT
Objective To assess the effect of the pulsatile catheter (PUCA) pump support on cardiac resuscitation in sheep,and to provide a new approach for saving cardiac arrest patients. Methods Cardiac arrest was induced by ventricular fibrillation in 11 sheep. These sheep were divided into three groups including no support (n=3), delayed support (n=2) and immediate support (n=6). Time for cardiac resuscitation and the ratio of success to failure in each group were recorded. Hemodynamic parameters including heart rate (HR), cardiac output (CO), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), central venous pressure(CVP),right ventricular end-diastolic pressure (RVEDP),left atrial pressure (LAP), and left ventricular end-diastolic pressure (LVEDP) were monitored and recorded at 5, 60 and 180 min after cardiac resuscitation with PUCA pump. Results Time for cardiac resuscitation in no support group, delayed support group and immediate support group was (38.3±5.8),(43.5±9.2) and (48.7±23.8)minutes, respectively(P＞0.05),and the ratio of success to failure was 0/3,0/2 and 5/1, respectively ( P＜0.05). After cardiac resuscitation with the PUCA pump support, MAP, SBP and DBP increased gradually(P＜0.05).Conclusions PUCA pump can maintain the hemodynamic stability in a sheep model of cardiac arrest,and can thus increase the success rate of cardiac resuscitation. It may be suitable for resuscitating cardiac arrest patients.