Impact of extracorporeal membranoxygenation on the microcirculation and integrity of the gastrointestinal tract

• Applicant: Dr. Maximilian Malfertheiner
• Subject Area: Pneumology, Thoracic Surgery
• Term: from 2016 to 2017
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 323290427

Severe respiratory failure, also referred to as acute respiratory distress syndrome (ARDS), is associated with a high morbidity and mortality. Veno-venous (VV)-ECMO is a valid therapy option in severe cases. ECMO draws blood from the venous circulation for oxygenation and CO2 removal, facilitating ventilation and allowing lung recovery. Since studies have demonstrated a favorable outcome of vv-ECMO therapy compared to conventional therapy in ARDS respiratory support with ECMO has increased worldwide. However with infection, bleeding, thrombosis and stroke there are serious adverse events observed with the use of ECMO therapy. This requires further intensive research to optimize treatment and reduce complications. In critical ill patients the gastrointestinal tract is often exposed to hypoperfusion, followed by a cascade of inflammation. Apoptosis of intestinal epithelial cells can cause a loss of the guts barrier function. This further leads to a systemic inflammatory response syndrome (SIRS) and a multi organ dysfunction associated with higher mortality. How an ECMO therapy can influence these processes is not known. Hypothetically the organ failure of the intestine can be alleviated by ECMO therapy through improved oxygenation and perfusion. However ECMO causes some degree of inflammatory response on its own and might not lead to an improvement of microcirculation. The research project aims at investigating the effect of ECMO therapy for respiratory failure on the gastrointestinal tract. Ovine experiments will be performed at the Centre of Research Excellence for Advanced Cardio-respiratory Therapies Improving OrgaN Support in Brisbane, Australia. Microcirculation of the intestine will be investigated using sidefield dark field imaging. Markers of apoptosis and systemic inflammation and changes in the microbiom of the animals will be analyzed.

• DFG Programme: Research Fellowships
• International Connection: Australia
• Host: Professor John Fraser, Ph.D.