Hemoperfusion of pigs with a carbon-cellulose cartridge: a pilot study revealing a new animal model of extended anaphylactic shock

To investigate the immune mechanisms underlying extracorporeal circulation-associated anaphylactoid reactions, we inserted externally perfused cartridges into the venous circulation of pigs, including a cellulose-coated activated-charcoal adsorbent (Adsorba(R) 300C), a polysulfone hollow-fiber membrane hemofilter, and polypropylene hollow-fiber-based heart-lung machine gas-exchange oxygenators. Blood was circulated using a roller pump, and the animals were monitored for systemic and pulmonary arterial pressures (SAP, PAP) changes, blood levels of complement C3a, thromboxane B2, and hemoglobin, blood cell counts and hematocrit. None of the cartridges caused major changes in these endpoints except the Adsorba(R) 300C, which displayed a fulminant anaphylactoid reaction characterized by profound hypotension, maximal pulmonary hypertension, hemoconcentration, thrombocytopenia and a surge of C3a and thromboxane B2, i.e., hallmarks of complement activation-related pseudoallergy. Within 15 min, the reaction advanced to profound hemodynamic collapse, which was managed with norepinephrine and cardiopulmonary resuscitation. After brief rebound hypertension, shock recurred despite repeated rounds of resuscitation until death. Considering that major adverse reactions with overlapping symptoms have been reported in humans subjected to hemoperfusion with the same cartridge, this porcine model provides clinically relevant insights into the mechanisms of extracorporeal circulation-induced anaphylactoid responses. Furthermore, the Adsorba(R) 300C-induced physiological changes along the immune-cardiopulmonary axis represents a new animal model for irreversible cardiovascular collapse escalating into shock.