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Using swine models to determine new paradigms in the management of cardiogenic and septic shocks as well as cardiac arrest (micro-axial pump, AT2, beta-blockers, CD31 agonists and hypertonic lactate solutions)
Belgium (BeMSA) - l'Université libre de Bruxelles ULB, Bruxelles
Experimental Laboratory of Intensive Care
Type of Research Project
- Basic science
What is the background of the project?
Our ICU (intensive care unit) laboratory runs currently several projects based on three different types of large animal models (on swine or, less often, on sheep): 1. Cardiogenic shock induced by a transient acute myocardial infarction; 2. Septic shock induced by fecal peritonitis; 3. Cardiac arrest induced by ventricular fibrillation. Each of the projects aims at mimicking as close as possible the pathological conditions of our ICU patients, in order to provide reliable pre-clinical research with an optimal external validity. We use cutting edge cardiovascular or neurologic multimodal assessments, thanks to numerous instruments and devices, mainly derived from the clinical research in the ICU environment or from applied physiology experimental set ups.
What is the aim of the project?
1. Cardiogenic shock: 1.1. Extending the paradigm of left ventricle unloading with the Impella® micro-axial pump during myocardial ischemia and reperfusion: is it still efficient on large myocardial infarction with cardiogenic shock? does it affect the organ perfusion and the microcirculation? does it reduce systemic pro-inflammatory reaction? 1.2. Protecting the myocardium from ischemia-reperfusion injuries with IV betablockers, with or without the hemodynamic support of a non-adrenergic inotropic agent as Levosimendan: does it reduce the infarct size? is it feasible from a safety point of view? are the potential benefit mainly related to heart rate reduction? 2. Septic shock: 2.1. Comparing Angiotensine 2 versus standard of care with Noradrenaline in the septic shock resuscitation: does it affect the left ventricle ventriculo-arterial coupling? the microcirculation? the pro-inflammatory reaction? 2.2. First animal testing of a CD31 agonist peptide perfusion during septic shock, in order to reactivate CD31 homeostasis role in the multiple endothelial functions: does it reduce capillary leakage? does is improve vasomotor tone? does it reduce coagulopathy and microcirculation derangements? 3. Cardiac arrest: 3.1. Administration of an hypertonic lactate solution in post cardiac arrest resuscitation: is it safe from a metabolic point of view? does it reduce post anoxic brain injuries?
What techniques and methods are used?
For the projects relying on the cardiogenic shock and the septic shock models, we use an exhaustive cardiovascular multimodal assessment including: - Hemodynamic monitoring with pulmonary artery catheter; - Comprehensive echocardiography; - Left ventricle pressure/volume loops; - Pulse wave analysis on multiples invasive arterial pressure signals; - Microcirculation camera for capillaries density and perfusion (IDF camera); - Coronary arteries pressure and velocities; - Coronary sinus catheterisation; - etc. For the project relying on the cardiac arrest model, we use an exhaustive neurologic multimodal assessment including: - Intracranial pressure; - Brain tissular oxygen tension (PbO2); - Cerebral microdialysis; - Cortical EEG; - Laser doppler cerebral flow; - etc.
What is the role of the student?
- The tasks will be done under supervision
What are the tasks expected to be accomplished by the student?
- Active participation in the animal sedation, set up preparation and surgical instrumentation; - Help in the recording of the different measurement and in the samples collecting; - Observation and discussion during the lab meetings; - Learn as much as possible about this unique opportunity to observe « live » applied physiopathology!
Will there be any theoretical teaching provided (preliminary readings, lectures, courses, seminars etc)
Readings -but not course/seminars- that have to be individually determined, following the student’s knowledge level and practical skills.
What is expected from the student at the end of the research exchange? What will be the general outcome of the student?
- No specific outcome is expected
What skills are required of the student? Is there any special knowledge or a certain level of studies needed?
Subjects passed: Intensive Care Medicine or Cardiology. To be familiar with basic knowledges in: - Cardiovascular physiology and Cardiology (circulatory failure, left ventricle pressure/volume loops, heart rate control, arterial pressure control, acute heart failure, etc.) - Intensive care medicine (sepsis, circulatory shock, microcirculation alteration, oxygen delivery, mechanical ventilation, etc.); - Cardiac arrest problematics (return of spontaneous circulation, post-cardiac arrest circulatory shock, post anoxic brain injury, etc.). To have already performed very basic surgery (ex: incision stitch) and simple vascular access (ex: venous catheter).
Are there any legal limitations in the student’s involvement
Type of students accepted
This project accepts: - Medical students - Graduated students (less than 6 months) - Pre-Medical students from the American-British system
- Numerous publications according to the type of experimental model chosen. The student shouldn’t hesitate to rather contact us before; for personal and tailor made advices.
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