Adam Gray
Research Mentor(s): Alvaro Rojas-Peña
Mentor Department: Department of Surgery-Transplantation
Authors: Adam Gray, Daniela Pelaez Palacio, Joanne Jung, Riya Gandhi, Rachel Riley , Orsolya Lautner-Csorba, Alvaro Rojas-Pena
Session: Session 1 (9:00am – 9:50am)
Presentation Type: Poster 44
Abstract
Adam Gray¹, Daniela Pelaez-Palacio MD¹, Joanne Jung¹, Riya Gandhi¹, Rachel Riley¹, Orsolya Lautner-Csorba PhD¹, Robert Bartlett MD¹, Alvaro Rojas-Pena MD¹² ¹ Department of Surgery, Extracorporeal Life Support (ECLS) Lab ² Department of Surgery, Section of Transplantation Extracorporeal membrane oxygenation (ECMO) is often used for supportive intervention due to multiorgan failure. Sepsis, a life-threatening organ dysfunction condition that is caused by a dysregulated response to infection, is often the cause of such multiorgan failure (20% of all deaths globally). When traditional methods fail, ECMO provides temporary cardiac and respiratory support while the underlying infection is treated. Nitric Oxide (NO) has shown potential as an adequate non-toxic bactericide due to its ability to directly interact with bacterial DNA, causing deamination or cross-linking, as well as diffusing freely into bacterial membranes facilitating the deactivation of enzymes by reacting with cellular iron-sulfur centers. However, the optimal dosage and effectiveness of the treatment has yet to be investigated. This study measured the effectiveness of NO as a bactericide in an in-vitro extracorporeal model of bacteremia. A blood based solution (packed red blood cells (pRBC) and plasma – 120mL) was used to prime ECLS circuits. Bacteria inoculation of Methicillin-Resistant Staphylococcus aureus (MRSA) and Pseudomona aeruginosa (106 CFU/mL, each) occurred at hour zero. The bacterial infused systems were then monitored for 12 hours with arterial blood gases (ABG’s) and activated clotting time (ACT’s) measured every 6 hours. The tests were conducted in three groups: 1) No Intervention group (NI), 2) NOS group (NO 30 ppm in Sweep Gas), 3) NOC group (NO-releasing coated circuits). Cultures were collected every 6 hours and sent to process bacterial colony counts. Data is presented in means and standard deviations. Nine in-vitro studies were completed successfully. The NOC group and the NOS group had a colony count decrease, baseline to H12, of -85%±7% cfu/mL and -91%±1% cfu/mL, respectively, while the NI group had a colony count increase of 1413%±1599% cfu/mL. (Figure 2). All studies were completed with acid-base variables (pH, pCO2, bicarbonate, pO2) maintained within expected parameters. Variations in electrolyte concentrations, particularly Potassium, were noticed; with Hemoglobin encountering an inversely proportional decrease to the potassium increase in both experimental groups. Nitric Oxide has potential to be used as a successful bactericide. Further studies and protocols need to be conducted for its application in-vivo.
