• Thornton S Mu, Amy M Becker, Aaron J Clark, Sherreen G Batts, Lee-Ann M Murata, and Uyehara Catherine F T CFT Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI, United States of America..
• Department of Pediatrics, Brooke Army Medical Center, San Antonio, Texas, United States of America.
• Plos One. 2019 Jan 1; 14 (10): e0223604.

IntroductionWhile extracorporeal membrane oxygenation (ECMO) is effective in preventing further hypoxemia and maintains blood flow in endotoxin-induced shock, ECMO alone does not reverse the hypotension. In this study, we tested whether concurrent vasopressor use with ECMO would provide increased circulatory support and blood flow, and characterized regional blood flow distribution to vital organs.MethodsEndotoxic shock was induced in piglets to achieve a 30% decrease in mean arterial pressure (MAP). Measurements of untreated pigs were compared to pigs treated with ECMO alone or ECMO and vasopressors.ResultsECMO provided cardiac support during vasodilatory endotoxic shock and improved oxygen delivery, but vasopressor therapy was required to return MAP to normotensive levels. Increased blood pressure with vasopressors did not alter oxygen consumption or extraction compared to ECMO alone. Regional microcirculatory blood flow (RBF) to the brain, kidney, and liver were maintained or increased during ECMO with and without vasopressors.ConclusionECMO support and concurrent vasopressor use improve regional blood flow and oxygen delivery even in the absence of full blood pressure restoration. Vasopressor-induced selective distribution of blood flow to vital organs is retained when vasopressors are administered with ECMO.

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