{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:11:24Z","timestamp":1768435884334,"version":"3.49.0"},"reference-count":40,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T00:00:00Z","timestamp":1692144000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Koeln Fortune Program","award":["343\/2015"],"award-info":[{"award-number":["343\/2015"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>(1) Background: Fluid resuscitation is a necessary part of therapeutic measures to maintain sufficient hemodynamics in extracorporeal membrane oxygenation (ECMO) circulation. In a post-hoc analysis, we aimed to investigate the impact of increased volume therapy in veno-arterial ECMO circulation on renal function and organ edema in a large animal model. (2) Methods: ECMO therapy was performed in 12 female pigs (Deutsche Landrasse \u00d7 Pietrain) for 10 h with subsequent euthanasia. Applicable volume, in regard to the necessary maintenance of hemodynamics, was divided into moderate and extensive volume therapy (MVT\/EVT) due to the double quantity of calculated physiologic urine output for the planned study period. Respiratory and hemodynamic data were measured continuously. Additionally, renal function and organ edema were assessed by blood and tissue samples. (3) Results: Four pigs received MVT, and eight pigs received EVT. After 10 h of ECMO circulation, no major differences were seen between the groups in regard to hemodynamic and respiratory data. The relative change in creatinine after 10 h of ECMO support was significantly higher in EVT (1.3 \u00b1 0.3 MVT vs. 1.8 \u00b1 0.5 EVT; p = 0.033). No major differences were evident for lung, heart, liver, and kidney samples in regard to organ edema in comparison of EVT and MVT. Bowel tissue showed a higher percentage of edema in EVT compared to MVT (77 \u00b1 2% MVT vs. 80 \u00b1 3% EVT; p = 0.049). (4) Conclusions: The presented data suggest potential deterioration of renal function and intestinal mucosa function by an increase in tissue edema due to volume overload in ECMO therapy.<\/jats:p>","DOI":"10.3390\/jcm12165330","type":"journal-article","created":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T10:09:33Z","timestamp":1692180573000},"page":"5330","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Fluid Management in Veno-Arterial Extracorporeal Membrane Oxygenation Therapy\u2014Analysis of an Experimental Pig Model"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5810-8626","authenticated-orcid":false,"given":"Ilija","family":"Djordjevic","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna","family":"Maier-Trauth","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery, HELIOS Klinikum Siegburg, 53721 Siegburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6568-6766","authenticated-orcid":false,"given":"Stephen","family":"Gerfer","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mara","family":"Elskamp","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Muehlbauer","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Maul","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University Hospital of Cologne, Experimental Medicine, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pia","family":"Rademann","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University Hospital of Cologne, Experimental Medicine, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Borko","family":"Ivanov","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery, HELIOS Klinikum Siegburg, 53721 Siegburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ihor","family":"Krasivskyi","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anton","family":"Sabashnikov","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elmar","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingo","family":"Slottosch","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Otto-von-Guericke University Magdeburg, 39106 Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8437-4119","authenticated-orcid":false,"given":"Thorsten","family":"Wahlers","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Liakopoulos","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Kerckhoff-Clinic Bad Nauheim, Campus Kerckhoff, University of Giessen, 35392 Giessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antje Christin","family":"Deppe","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.1016\/j.jacc.2014.03.046","article-title":"Extracorporeal membrane oxygenation in cardiopulmonary disease in adults","volume":"63","author":"Abrams","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1053\/j.jvca.2009.08.002","article-title":"Extracorporeal membrane oxygenation for treating severe cardiac and respiratory failure in adults: Part 2-technical considerations","volume":"24","author":"Sidebotham","year":"2010","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"P27","DOI":"10.1051\/ject\/201143P27","article-title":"Troubleshooting adult ECMO","volume":"43","author":"Sidebotham","year":"2011","journal-title":"J. Extra Corpor. Technol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1161\/01.CIR.0000023891.80661.AD","article-title":"Successful cardiopulmonary resuscitation after cardiac arrest as a \u201csepsis-like\u201d syndrome","volume":"106","author":"Adrie","year":"2002","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/1757-7241-18-29","article-title":"Capillary leakage in post-cardiac arrest survivors during therapeutic hypothermia\u2014A prospective, randomised study","volume":"18","author":"Heradstveit","year":"2010","journal-title":"Scand. J. Trauma. Resusc. Emerg. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/CCM.0b013e3181feeb15","article-title":"Fluid resuscitation in septic shock: A positive fluid balance and elevated central venous pressure are associated with increased mortality","volume":"39","author":"Boyd","year":"2011","journal-title":"Crit. Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1378\/chest.07-1496","article-title":"Fluid therapy in resuscitated sepsis: Less is more","volume":"133","author":"Durairaj","year":"2008","journal-title":"Chest"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1186\/s13054-015-0970-1","article-title":"A positive fluid balance is an independent prognostic factor in patients with sepsis","volume":"19","author":"Acheampong","year":"2015","journal-title":"Crit. Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.jcrc.2014.09.002","article-title":"Positive fluid balance as a prognostic factor for mortality and acute kidney injury in severe sepsis and septic shock","volume":"30","author":"Freitas","year":"2015","journal-title":"J. Crit. Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"R246","DOI":"10.1186\/cc13072","article-title":"Fluid balance and cardiac function in septic shock as predictors of hospital mortality","volume":"17","author":"Micek","year":"2013","journal-title":"Crit. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.ajem.2014.11.016","article-title":"Fluid balance in sepsis and septic shock as a determining factor of mortality","volume":"33","author":"Sirvent","year":"2015","journal-title":"Am. J. Emerg. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.1007\/s00134-014-3360-2","article-title":"Impact of fluid balance on outcome of adult patients treated with extracorporeal membrane oxygenation","volume":"40","author":"Schmidt","year":"2014","journal-title":"Intensive Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.jcrc.2016.09.017","article-title":"Early fluid resuscitation and volume therapy in venoarterial extracorporeal membrane oxygenation","volume":"37","author":"Staudacher","year":"2017","journal-title":"J. Crit. Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1186\/s13054-018-2211-x","article-title":"Permissive fluid volume in adult patients undergoing extracorporeal membrane oxygenation treatment","volume":"22","author":"Kim","year":"2018","journal-title":"Crit. Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2694","DOI":"10.1097\/CCM.0b013e318258ff01","article-title":"Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy","volume":"40","author":"Selewski","year":"2012","journal-title":"Crit. Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1097\/MAT.0000000000000860","article-title":"Fluid Balance and Recovery of Native Lung Function in Adult Patients Supported by Venovenous Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy","volume":"65","author":"McCanny","year":"2019","journal-title":"ASAIO J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1186\/s13054-022-04056-3","article-title":"Fluid challenge in critically ill patients receiving haemodynamic monitoring: A systematic review and comparison of two decades","volume":"26","author":"Messina","year":"2022","journal-title":"Crit. Care."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"154108","DOI":"10.1016\/j.jcrc.2022.154108","article-title":"Agreement between subcostal and transhepatic longitudinal imaging of the inferior vena cava for the evaluation of fluid responsiveness: A systematic review","volume":"71","author":"Astuto","year":"2022","journal-title":"J. Crit. Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s40635-023-00529-z","article-title":"Inferior vena cava distensibility from subcostal and trans-hepatic imaging using both M-mode or artificial intelligence: A prospective study on mechanically ventilated patients","volume":"11","author":"Sanfilippo","year":"2023","journal-title":"Intensive Care Med. Exp."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.1007\/s00134-015-4134-1","article-title":"Passive leg raising for predicting fluid responsiveness: A systematic review and meta-analysis","volume":"42","author":"Monnet","year":"2016","journal-title":"Intensive Care Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s13054-017-1938-0","article-title":"End-expiratory occlusion maneuver to predict fluid responsiveness in the intensive care unit: An echocardiographic study","volume":"22","author":"Georges","year":"2018","journal-title":"Crit. Care"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Djordjevic, I., Liakopoulos, O., Elskamp, M., Maier-Trauth, J., Gerfer, S., Muhlbauer, T., Slottosch, I., Kuhn, E., Sabashnikov, A., and Rademann, P. (2022). Concomitant Intra-Aortic Balloon Pumping Significantly Reduces Left Ventricular Pressure during Central Veno-Arterial Extracorporeal Membrane Oxygenation-Results from a Large Animal Model. Life.","DOI":"10.3390\/life12111859"},{"key":"ref_23","first-page":"293","article-title":"Normal physiological values for conscious pigs used in biomedical research","volume":"40","author":"Hannon","year":"1990","journal-title":"Lab. Anim. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Anton-Martin, P., Quigley, R., Dhar, A., Bhaskar, P., and Modem, V. Early Fluid Accumulation and Intensive Care Unit Mortality in Children Receiving Extracorporeal Membrane Oxygenation. ASAIO J., 2020.","DOI":"10.1097\/MAT.0000000000001167"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1097\/PCC.0000000000001349","article-title":"The Impact of Fluid Overload on Outcomes in Children Treated With Extracorporeal Membrane Oxygenation: A Multicenter Retrospective Cohort Study","volume":"18","author":"Selewski","year":"2017","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1097\/MAT.0000000000001702","article-title":"Extracorporeal Life Support Organization Guidelines for Fluid Overload, Acute Kidney Injury, and Electrolyte Management","volume":"68","author":"Bridges","year":"2022","journal-title":"ASAIO J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/MAT.0000000000001000","article-title":"Acute Kidney Injury, Fluid Overload, and Outcomes in Children Supported With Extracorporeal Membrane Oxygenation for a Respiratory Indication","volume":"66","author":"Mallory","year":"2020","journal-title":"ASAIO J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1186\/s13054-014-0675-x","article-title":"Combination of extracorporeal membrane oxygenation and continuous renal replacement therapy in critically ill patients: A systematic review","volume":"18","author":"Chen","year":"2014","journal-title":"Crit. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1016\/j.athoracsur.2013.09.008","article-title":"Complications of Extracorporeal Membrane Oxygenation for Treatment of Cardiogenic Shock and Cardiac Arrest: A Meta-Analysis of 1,866 Adult Patients","volume":"97","author":"Cheng","year":"2014","journal-title":"Ann. Thorac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1159\/000479342","article-title":"Review of Extracorporeal Membrane Oxygenation and Dialysis-Based Liver Support Devices for the Use of Nephrologists","volume":"46","author":"Hamdi","year":"2017","journal-title":"Am. J. Nephrol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1840","DOI":"10.4103\/0366-6999.237406","article-title":"Extracorporeal Membrane Oxygenation Improving Survival and Alleviating Kidney Injury in a Swine Model of Cardiac Arrest Compared to Conventional Cardiopulmonary Resuscitation","volume":"131","author":"Yuan","year":"2018","journal-title":"Chin. Med. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1159\/000517896","article-title":"Adjunct Use of Continuous Renal Replacement Therapy with Extracorporeal Membrane Oxygenation Achieves Negative Fluid Balance and Enhances Oxygenation Which Improves Survival in Critically Ill Patients without Kidney Failure","volume":"51","author":"Thomas","year":"2022","journal-title":"Blood Purif."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1097\/MAT.0b013e3182579218","article-title":"A multicenter international survey of renal supportive therapy during ECMO: The Kidney Intervention During Extracorporeal Membrane Oxygenation (KIDMO) group","volume":"58","author":"Fleming","year":"2012","journal-title":"ASAIO J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1111\/sdi.12965","article-title":"Continuous renal replacement therapy in patients treated with extracorporeal membrane oxygenation","volume":"34","author":"Selewski","year":"2021","journal-title":"Semin. Dial."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.ejvs.2018.08.055","article-title":"Volume Based Resuscitation and Intestinal Microcirculation after Ischaemia\/Reperfusion Injury: Results of an Exploratory Aortic Clamping Study in Pigs","volume":"57","author":"Behem","year":"2019","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1203\/PDR.0b013e3181e4c9f8","article-title":"Extracorporeal membrane oxygenation causes loss of intestinal epithelial barrier in the newborn piglet","volume":"68","author":"Kurundkar","year":"2010","journal-title":"Pediatr. Res."},{"key":"ref_37","first-page":"4347","article-title":"Protective effect of extracorporeal membrane oxygenation on intestinal mucosal injury after cardiopulmonary resuscitation in pigs","volume":"18","author":"Liang","year":"2019","journal-title":"Exp. Ther. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13019-015-0211-3","article-title":"The influence of extracorporeal membrane oxygenation therapy on intestinal mucosal barrier in a porcine model for post-traumatic acute respiratory distress syndrome","volume":"10","author":"Ni","year":"2015","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/1749-8090-9-72","article-title":"Effects of continuous renal replacement therapy on intestinal mucosal barrier function during extracorporeal membrane oxygenation in a porcine model","volume":"9","author":"He","year":"2014","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_40","first-page":"3861","article-title":"Effect of ulinastatin combined with mild therapeutic hypothermia on intestinal barrier dysfunction following cardiopulmonary resuscitation in rats","volume":"18","author":"Zhang","year":"2019","journal-title":"Exp. Ther. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/16\/5330\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:34:55Z","timestamp":1760128495000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/16\/5330"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,16]]},"references-count":40,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["jcm12165330"],"URL":"https:\/\/doi.org\/10.3390\/jcm12165330","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,16]]}}}