Recent results of a study conducted in a porcine model prompt clinicians and scientists to rethink resuscitation approaches to discriminate dead or irreparable tissues and organs from those that can be revived.

Ischemia and reperfusion can lead to disease or mortality. Interruption of the blood supply to an organ or organs leads to hypoxic injury and possible cell death. In cases where blood flow can be restored, inflammatory cells infiltrate ischemic tissues, resulting in further reperfusion injury and organ dysfunction.

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Ischemic tissue injury in conjunction with reperfusion affects a wide range of clinical conditions, including single organ injury, such as that which occurs during myocardial infarction; acute kidney injury or solid organ transplantation. These processes also affect multiple organs simultaneously (eg, during cardiac arrest and cardiopulmonary resuscitation).Mechables A report by David Andrijevic and colleagues (Nature 2022;608:405-12) describes a novel experimental approach to multi-organ ischemia and reperfusion injury involving the use of an advanced extracorporeal perfusion system combined with a perfused cytoprotectant to revive organs. in a porcine model (figure 1). The results are remarkable and have implications for organ transplantation,

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The study was inspired by earlier work from the same laboratory, in which extracorporeal perfusion was used for 4 hours after death to restore isolated circulation and neural functions in the brains of pigs. In the current work, these findings were extended to multiorgan ischemia and reperfusion injury. Ventricular fibrillation was introduced to cause cardiac arrest in an anesthetized pig that had received anticoagulation; followed by complete cessation of circulation. Core body temperature was maintained between 36 and 37°C for 1 hour, allowing warm ischemic tissue damage to occur. Subsequently, the cannulated femoral artery and vein were connected to an advanced extracorporeal perfusion system that included an oxygenator, device that generates pulsatile arterial blood flow, an automated hemodiafiltration unit, and an acellular, hemoglobin-based, non-coagulant, and cytoprotective perfusion (Figure 1). Real-time measurements of metabolites and critical circulatory variables (eg, circulatory flow rates and central arterial and venous pressure) allowed system tuning. The design included several control conditions, including a group of pigs resuscitated by conventional extracorporeal membrane oxygenation (ECMO). circulatory flow rates and arterial and central venous pressure) allowed adjustment of the system. The design included several control conditions, including a group of pigs resuscitated by conventional extracorporeal membrane oxygenation (ECMO). circulatory flow rates and arterial and central venous pressure) allowed adjustment of the system. The design included several control conditions, including a group of pigs resuscitated by conventional extracorporeal membrane oxygenation (ECMO).