To establish extracorporeal membrane oxygenation (ECMO) circulatory system on the basis of donation after brain death plus cardiac death (DBCD) with liver injury in dogs.

Brain death model via increasing intracranial pressure gradually were replicated in 20 male dogs. After confirming the brain death, femoral arteriovenous ECMO catheters were inserted. Pringle-Maneuver was used to block the portal vein and hepatic artery flow for 60 minutes. Extracorporeal membrane oxygenation system was established on the basis of DBCD with liver injury. Levels of lactate, Na⁺, K⁺, Ca²⁺, Glucose, alanine aminotransferase (ALT), aspartic transaminase (AST), lactic dehydrogenase (LDH), tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) before and after the blockade was measured. Student′s t test was used to analyze the data.

Brain death model were replicated successfully in all 20 dogs, among which 2 died of cardiac arrest after clamp removed. ECMO system was established successfully in 18 (90.0%) dogs. 60 minutes after blockade, the liver appeared obvious hypoxic-ischemic manifestation. Blood lactate concentration was significant higher after blockade [(4.57±0.35) mmol/L vs (1.18±0.15) mmol/L, t=8.91, P<0.001] as well as the level of ALT, AST and LDH [(400.40±15.13) U/L vs (27.40±1.98) U/L, (444.75±19.65) U/L vs (25.40±0.98) U/L, (274.00±19.54) U/L vs (55.17±6.26) U/L, t=24.45, 21.32, 10.67, all P<0.001]. The TNF-α and IL-6 concentration were also significant higher after blockade compare to the baseline [(29.23±1.85) pg/ml vs (8.37±1.30) pg/ml, t=9.21, P<0.001; (5.54±1.11) pg/ml vs (2.25±0.81) pg/ml, t=2.39, P=0.03].

This study successfully established a liver injury model with brain death, which provides an ideal model to investigate the protection of ECMO on DBCD donors with liver injury.