Extracorporeal membrane oxygenation combined with ultrafiltration technique for treatment of kidney injury after severe hemorrhagic shock in rabbits

Objective To investigate the effect of extracorporeal membrane oxygenation (ECMO) combined with ultrafiltration in treatment of kidney injury induced by serious hemorrhagic shock in rabbits.Methods Models of pressure-controlled hemorrhagic shock was developed in 24 New Zealand white rabbits which were divided into unresuscitation group (n =8),ECMO combined with ultrafiltration group (combined resuscitation group,n =8),and fluid resuscitation group (n =8) according to the random number table.Heart rate was monitored via electrocardiograph and arterial pressure via fermoral artery catheter.Blood samples were collected pre-and post-shock and after resuscitation to measure levels of lactic acid,serum creatinine,IL-6,and TNF-α.Kidney samples were collected for measurement of histopathological changes via HE staining,expression of heat shock protein 70 (HSP70) via immunohistochemical staining.Results Arterial pressure was (53.1 ± 11.4) mmHg in combined resuscitation group,higher than (41.3 ± 11.1) mmHg in fluid resuscitation group and (25.9 ± 10.5) mmHg in unresuscitation group (F =41.425,P ＜ 0.05).Hemorrhagic shock induced significant up-regulation of lactic acid,serum creatinine,IL-6,and TNF-α(P ＜ 0.05),but all were lowered after resuscitation,especially in combined resuscitation group (P ＜ 0.05).HE staining showed the degree of kidney tissue necrosis and inflammatory cytokine infiltration in combined resuscitation group alleviated notably compared with fluid resuscitation group.Median and interquartile values of HSP70 were 17 828.960 0 (15 779.865 0-21 751.980 0) in unresuscitation group,2 714.270 0 (1 339.215 0-7 616.950 0) in fluid resuscitation group,and 262.930 0 (198.820 0-538.195 0) in combine resuscitation group,with statistical differences among groups(P ＜ 0.05).Conclusion ECMO combined with ultrafiltration is superior to conventional fluid resuscitation in improving hypoxia tissue injury and inflammatory reaction after hemorrhagic shock and is beneficial to attenuating kidney injury. Key words: Shock, hemorrhagic ;  Extracorporeal membrane oxygenation ;  Ultrafiltration