Extracorporeal Life Support in a Porcine Model of Septic Endotoxemia with Acute Pulmonary Hypertension: An Experimental Study

Sandrio, Stany; Krebs, Joerg; Spanier, Tobias; Beck, Grietje; Thiel, Manfred; Graf, Peter Tobias

doi:10.3390/jcm14176342

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Extracorporeal Life Support in a Porcine Model of Septic Endotoxemia with Acute Pulmonary Hypertension: An Experimental Study

by

Stany Sandrio

^*,

Joerg Krebs

,

Tobias Spanier

,

Grietje Beck

,

Manfred Thiel

and

Peter Tobias Graf

Department of Anesthesiology and Critical Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68165 Mannheim, Germany

^*

Author to whom correspondence should be addressed.

J. Clin. Med. 2025, 14(17), 6342; https://doi.org/10.3390/jcm14176342 (registering DOI)

Submission received: 30 July 2025 / Revised: 29 August 2025 / Accepted: 5 September 2025 / Published: 8 September 2025

(This article belongs to the Special Issue Key Advances in the Treatment of the Critically Ill: 3rd Edition)

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Abstract

Background: This study evaluated the effects of veno-arterial (V-A) and veno-venoarterial (V-VA) ECMO in a porcine model of septic endotoxemia-induced acute pulmonary arterial hypertension (PAH). Our hypotheses were as follows: (1) V-VA ECMO lowers pulmonary vascular resistance (PVR) by delivering oxygenated blood to the pulmonary circulation, and (2) both V-A and V-VA ECMO improve perfusion to vital organs while simultaneously unloading the right ventricle (RV). Methods: Acute PAH was induced with Salmonella abortus equi lipopolysaccharide (LPS) in 34 pigs. Animals were randomized to either a control group without ECMO or to two groups receiving V-A or V-VA ECMO. Results: All animals developed PAH after one hour of LPS infusion: mean pulmonary artery pressure (PAP) increased significantly from 26 (24–30) mmHg to 40 (34–46) mmHg (p < 0.0001), and PVR increased from 314 (221–390) to 787 (549–1073) (p < 0.0001). Neither V-A nor V-VA ECMO significantly reduced PVR compared to controls. RV end-diastolic area increased in the control group [6.1 (4.3–8.6) cm vs. 8.5 (7.8–9.7) cm, p = 0.2], but not in the V-A [4.7 (3.3–7.6) cm] and V-VA [4.3 (2.5–8.3) cm] ECMO groups. Blood flow in the cranial mesenteric artery and celiac trunk did not differ significantly with or without ECMO. Conclusions: Elevating pulmonary artery oxygen tension through V-A or V-VA ECMO did not reduce PVR or PAP. However, both ECMO configurations effectively unloaded the RV and maintained perfusion to abdominal organs.

Keywords: sepsis; pulmonary hypertension; veno-arterial extracorporeal membrane oxygenation; veno-venoarterial extracorporeal membrane oxygenation; lipopolysaccharide; right ventricle

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MDPI and ACS Style

Sandrio, S.; Krebs, J.; Spanier, T.; Beck, G.; Thiel, M.; Graf, P.T. Extracorporeal Life Support in a Porcine Model of Septic Endotoxemia with Acute Pulmonary Hypertension: An Experimental Study. J. Clin. Med. 2025, 14, 6342. https://doi.org/10.3390/jcm14176342

AMA Style

Sandrio S, Krebs J, Spanier T, Beck G, Thiel M, Graf PT. Extracorporeal Life Support in a Porcine Model of Septic Endotoxemia with Acute Pulmonary Hypertension: An Experimental Study. Journal of Clinical Medicine. 2025; 14(17):6342. https://doi.org/10.3390/jcm14176342

Chicago/Turabian Style

Sandrio, Stany, Joerg Krebs, Tobias Spanier, Grietje Beck, Manfred Thiel, and Peter Tobias Graf. 2025. "Extracorporeal Life Support in a Porcine Model of Septic Endotoxemia with Acute Pulmonary Hypertension: An Experimental Study" Journal of Clinical Medicine 14, no. 17: 6342. https://doi.org/10.3390/jcm14176342

APA Style

Sandrio, S., Krebs, J., Spanier, T., Beck, G., Thiel, M., & Graf, P. T. (2025). Extracorporeal Life Support in a Porcine Model of Septic Endotoxemia with Acute Pulmonary Hypertension: An Experimental Study. Journal of Clinical Medicine, 14(17), 6342. https://doi.org/10.3390/jcm14176342

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Extracorporeal Life Support in a Porcine Model of Septic Endotoxemia with Acute Pulmonary Hypertension: An Experimental Study

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