Hemoperfusion using dual pulsatile pump in paraquat poisoning

Suh, Gil J.; Lee, Christopher C.; Jo, Ik J.; Shin, Sang D.; Lee, Jung C.; Min, Byung G.; Singer, Adam J.

doi:10.1016/j.ajem.2007.09.022

« Previous Next »American Journal of Emergency Medicine
Volume 26, Issue 6 , Pages 641-648, July 2008

Hemoperfusion using dual pulsatile pump in paraquat poisoning

Gil J. Suh, MD
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
Christopher C. Lee, MD
- Department of Emergency Medicine, Center for International Emergency Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA
- Corresponding author. Department of Emergency Medicine, Center for International Emergency Medicine, Stony Brook University Medical Center, School of Medicine, Stony Brook, NY 11794, USA. Tel.: +1 631 444 3880; fax: +1 631 444 3919.
Ik J. Jo, MD
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
Sang D. Shin, MD
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
Jung C. Lee, MD
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
Byung G. Min, MD
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
Adam J. Singer, MD
- Department of Emergency Medicine, Center for International Emergency Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA

Received 5 May 2007; received in revised form 26 September 2007; accepted 27 September 2007.

Abstract

Introduction

Hemoperfusion is an effective method for removing paraquat from the body. However, the need for special equipment and personnel to perform hemoperfusion limits its applicability in the emergency department. A portable, user-friendly extracorporeal life support system (Twin Pulse Life Support [T-PLS]) capable of producing dual pulsatile flow by an electromechanical blood pump has recently been developed. We compared the effects of hemoperfusion using traditional and dual-pulsatile pumps in a paraquat-intoxicated canine model. We hypothesized that T-PLS would be as effective as nonpulsatile hemoperfusion in reducing plasma and tissue paraquat levels.

Methods

Twelve adult male mongrel dogs were randomly assigned to hemoperfusion using a standard nonpulsatile pump (n = 6) or the T-PLS (n = 6). Paraquat intoxication was induced by intramuscular injection of paraquat (30 mg/kg). One hour after paraquat administration, hemoperfusion was performed for 4 hours at a flow rate of 125 mL/min. Periodic hemodynamic, chemical, and hematologic parameters as well as paraquat blood levels were obtained before and during the experiment. All animals were euthanized after completing 4 hours of hemoperfusion, and tissue levels of paraquat were determined.

Results

During hemoperfusion, hemodynamic parameters including aortic blood pressure, heart rate, rectal temperature, and Sao₂ showed no significant difference between the T-PLS group and the nonpulsatile pump groups. Chemical and hematologic parameters such as serum electrolytes, platelet level, creatinine concentration, the ratio of blood urea nitrogen (BUN) to creatinine, alanine aminotransferase/aspartate aminotransferase (ALS/AST) levels, and plasma hemoglobin concentration as an indicator of hemolysis also showed no between-group differences. Plasma paraquat concentrations and lung and kidney tissue paraquat concentrations were also similar in both groups.

Conclusions

In this experimental canine study, T-PLS was as effective as traditional nonpulsatile hemoperfusion in reducing plasma and tissues paraquat levels. There were also no differences in hemodynamic, chemical, and hematologic parameters between the groups. Hemoperfusion using T-PLS may play a role as an alternative method for treating patients with paraquat poisoning.