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1 The Johns Hopkins University School of Medicine
2 Johns Hopkins Medical Institutions
3 Johns Hopkins University School of Medicine
4 Vanderbilt University Medical Center
5 John Hopkins University, School of Medicine
* To whom correspondence should be addressed. E-mail: ashoukas{at}bme.jhu.edu.
Extracorporeal circulation provides critical life support in the face of cardiopulmonary or renal failure, but it also introduces a host of unique morbidities characterized by edema formation, cardiac insufficiency, autonomic dysfunction, and altered vasomotor function. We tested the hypothesis that cyclohexanone (CHX), a solvent used in production of extracorporeal circuits and IV bags, leaches into the contained fluids and can replicate these clinical morbidities. Crystalloid fluid samples from circuits and IV bags were analyzed using gas chromatography-mass spectrometry to provide a range of clinical CHX exposure levels, revealing CHX contamination of sampled fluids (9.63-3694 µg/L). In vivo rat studies were conducted (n=49) to investigate the effects of a bolus intravenous infusion of CHX vs. saline alone on cardiovascular function, baroreflex responsiveness, and edema formation. Cardiovascular function was evaluated using cardiac output, heart rate, stroke volume, vascular resistance, arterial pressure, and ventricular contractility. Baroreflex function was assessed using mean femoral arterial pressure responses to bilateral carotid occlusion. Edema formation was assessed using the ratio of wet-to-dry organ weights for lungs, liver, kidneys, and skin. CHX infusion led to systemic hypotension; pulmonary hypertension; depressed contractility, heart rate, stroke volume, and cardiac output; and elevated vascular resistance (p<0.05). Mean arterial pressure responsiveness to carotid occlusion was dampened after CHX infusion (from +17.25±1.8 to +5.61±3.2 mmHg, p<0.05). CHX infusion led to significantly higher wet:dry weight ratios vs. saline only (3.8±0.06 vs. 3.5±0.05, p<0.05). CHX can reproduce clinical cardiovascular, neurological, and edema morbidities associated with extracorporeal circulatory treatment.
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