Controlled reperfusion prevents pulmonary injury after 24 hours of lung preservation Ari O Halldorsson, MD, Michael Kronon, MD, Bradley S Allen, MD, Shaikh.

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Presentation transcript:

Controlled reperfusion prevents pulmonary injury after 24 hours of lung preservation Ari O Halldorsson, MD, Michael Kronon, MD, Bradley S Allen, MD, Shaikh Rahman, MS, Tingrong Wang, MD, Michael Layland, BS, Douglas Sidle, BS The Annals of Thoracic Surgery Volume 66, Issue 3, Pages 877-884 (September 1998) DOI: 10.1016/S0003-4975(98)00673-0

Fig 1 (A) Experimental model of controlled pulmonary reperfusion. Blood is taken from the femoral artery and combined with a modified crystalloid solution using a BCD as a mixer, and then passed through a white cell (WBC) filter before return to the pulmonary artery. The pressure in the distal pulmonary artery is constantly measured and kept between 20 and 30 mm Hg. (B) The modified reperfusate is given into the left pulmonary artery distal to the clamp, and is allowed to return to the pig through the pulmonary veins. The Annals of Thoracic Surgery 1998 66, 877-884DOI: (10.1016/S0003-4975(98)00673-0)

Fig 2 Postreperfusion pulmonary compliance expressed as percent recovery compared with baseline values. Uncontrolled reperfusion with unmodified blood significantly lowered pulmonary compliance indicating a reperfusion injury. In contrast, controlled reperfusion using a leukocyte-depleted modified blood solution, given at a low pressure, resulted in almost full recovery of pulmonary compliance (SE = standard error; ∗p < 0.001.) The Annals of Thoracic Surgery 1998 66, 877-884DOI: (10.1016/S0003-4975(98)00673-0)

Fig 3 Postreperfusion pulmonary vascular resistance expressed as percent increase compared with baseline values. The pulmonary vascular resistance increased significantly when the lung was reperfused with unmodified blood in an uncontrolled fashion. Conversely, lungs undergoing controlled reperfusion by delivering a modified reperfusate at a low pressure for 10 minutes before restoring native circulation experienced minimal change in pulmonary vascular resistance. (SE = standard error; ∗p < 0.001.) The Annals of Thoracic Surgery 1998 66, 877-884DOI: (10.1016/S0003-4975(98)00673-0)

Fig 4 Postreperfusion arterial oxygenation (PO2) measured using an inspired oxygen fraction of 1.0 and positive end-expiratory pressure = 5 cm H2O. Uncontrolled reperfusion resulted in a very low posttransplant PO2, implying severe alveolar damage in this group. In contrast, the PO2 was almost normal in animals receiving controlled reperfusion implying very little alveolar injury. (∗p < 0.001.) The Annals of Thoracic Surgery 1998 66, 877-884DOI: (10.1016/S0003-4975(98)00673-0)

Fig 5 A proposed clinical model of controlled pulmonary reperfusion. It is similar to experimental model except blood is taken from the aorta instead of the femoral artery. This avoids the problems associated with groin cannulation, and is easily accomplished as the aorta can be cannulated through any incision used for donor implantation. (WBC = white blood cell.) The Annals of Thoracic Surgery 1998 66, 877-884DOI: (10.1016/S0003-4975(98)00673-0)