Novel Extracorporeal Life Support System to Mitigate Ischemia-Reperfusion Injury During Prolonged Aortic and Inferior Vena Caval Occlusion

Extracorporeal membrane oxygenation (ECMO) and endovascular balloon occlusion of the aorta (REBOA) have been reported to manage hemodynamics and reduce blood loss and transfusion requirements during high-risk abdominal surgeries. We investigated whether a venoarterial ECMO perfusion system with small-bore femoral arterial and venous cannulas (8F/10F) and endovascular hemorrhage control devices placed in the aorta and inferior vena cava (REBOAVC) can prolong the duration of survivable occlusion in a porcine hemorrhage model. Pigs underwent 30% controlled hemorrhage with subsequent supraceliac/suprahepatic REBOAVC (90 minutes full occlusion) with (n = 10) or without (n = 3) ECMO. Balloon deflation was followed by immediate transfusion of hemorrhaged blood and a 3 hour reperfusion/critical care period. A subset of ECMO pigs (n = 5) underwent hemofiltration with an Oxiris filter. Extracorporeal membrane oxygenation pigs showed greater survival (90% vs. 0%), improved lactate clearance (3.7 ± 0.8 vs. 13.7 ± 1.8 mmol/L), decreased norepinephrine requirement (18 ± 5 vs. 56 ± 3 μg/kg), and reduced histologic jejunum and kidney ischemia scores versus no ECMO (p < 0.05). Hemofiltration successfully managed hyperkalemia, decreased systemic inflammatory cytokine levels, and aided in acid-base correction from ischemia-reperfusion injury during resuscitation. Small-bore cannulas provided sufficient perfusion to distal organs in a porcine model suggesting that an integrated ECMO-REBOAVC-hemofiltration system has the potential to improve survivability for prolonged occlusion time.