EFFECT OF HEMOCARBOPERFUSION ON ORGAN BLOOD-FLOW AND SURVIVAL IN PORCINE ENDOTOXIC-SHOCK

Objective: To evaluate the effects of hemocarboperfusion on hemodynami cs, organ blood flow, and survival in endotoxin shock. Design: Prospec tive, placebo-controlled animal trial. Setting: Research laboratory in a major university teaching hospital. Subjects: Pentobarbital-anesthe tized pigs. Interventions: Twenty eight pentobarbital-anesthetized pig s (18.5 to 22.3 kg) received 100 mu g/kg of Escherichia coli endotoxin (lipopolysaccharide 0127) over 30 mins. Group 1 animals (n = 14) were controls and had blood diverted through an extracorporeal circuit wit hout activated charcoal for 60 mins after lipopolysaccharide infusion. Group 2 animals (n = 14) underwent nonpulsatile hemocarboperfusion (a ctivated charcoal SCN-1K). Measurements and Main Results: Mean arteria l pressure, cardiac output, systemic vascular resistance, mean pulmona ry arterial pressure, pulmonary vascular resistance, oxygen delivery, and regional blood flow (radiolabeled microsphere technique) were dete rmined at baseline and every 30 mins for 150 mins. Results are present ed as mean +/- SD. Parameters in the two groups were compared by two w ay analysis of variance. A p < .05 was considered significant. The sur vival rate was ten (71%) of 14 animals in group 1 compared with 14 (10 0%) of 14 animals in group 2 (p < .05, Fisher's exact test). The mean cardiac output at the end of hemocarboperfusion was 1.6 +/- 0.6 L/min in group 1 compared with 3.0 +/- 0.9 L/min in group 2, and remained lo wer in group 1 animals throughout the experiment. Pulmonary arterial p ressure and pulmonary vascular resistance were lower in the hemocarbop erfusion treated animals during and after hemocarboperfusion. Systemic Vascular resistance increased by 70% after lipopolysaccharide infusio n and returned to baseline values in the hemocarboperfusion group but remained increased in controls. Oxygen delivery was lower in group 1 a t 90 and 150 mins (287 +/- 34 vs. 478 +/- 48 mL/min and 251 +/- 24 vs. 356 +/- 21 mL/min, respectively). Blood flow rates to the brain (38.5 +/- 7.5 vs. 27.1 +/- 5.4 mL/min/100 g), large intestine (26.6 +/- 1.1 vs. 17.7 +/- 2.5 mL/ min/100 g), and adrenal cortex (200 +/- 45 vs. 1 39 +/- 41 mL/min/100 g) were higher in the hemocarboperfusion group at the completion of carboperfusion but not at later time points. Conclu sion: These data suggest that hemocarboperfusion may be of value in th e treatment of septic shock.