Total body washout for the treatment of endotoxin shock. An experimental study

Y. Nakamura, A. Wakabayashi, T. Woolley, P. Mullin, Y. Ito and J. E. Connolly

In order to study the therapeutic effects of total body washout (TBW) in experimental endotoxin shock, we used the following procedure. Seventeen rabbits (controls) received Escherichia coli endotoxin (5 mg/kg) intravenously and were observed for 12 hours. Shock developed in 14 rabbits; they died in 5.2 +/- 1.0 (mean +/- SD) hours, with a survival rate of 18%. Seventeen rabbits were subjected to TBW only. Muscle temperature was lowered to 25 C with a pump oxygenator circuit and the animals were exsanguinated. After residual blood was flushed out with cold, lactated Ringer solution, the animals were rewarmed with another circuit that was primed with homologous blood. Fourteen animals survived (82%). Two hours after E. coli endotoxin was injected intravenously 17 animals were treated with TBW. The survival rate (53%) of this group was significantly higher than in the control group (18%) (P less than .005). Eight nonsurvivors showed hypotension and acidosis even after TBW treatment, thus indicating the irreversibility of their endotoxin shock. This study indicates that endotoxin shock may be reversed by TBW if it is instituted before irreversible cellular damage.