Anticoagulation during ECMO: The Past, Present and Future

Abstract

In recent years, many medical centres started to use extracorporeal membrane oxygenator (ECMO) support as the last treatment option for critically ill patients when the conventional therapy fails. There are significant improvements in ECMO management since the early days of its application. In this report, we aimed to review several aspects in this complex treatment modality. One of the main areas reviewed in this article will be the anticoagulation strategy used during ECMO support and the tests utilized for monitoring coagulation parameters. Additionally, technologies used in ECMO circuits and new advances in the field were reviewed.

New Trends, Advantages and Disadvantages in Anticoagulation and Coating Methods Used in Extracorporeal Life Support Devices

“…Indeed, coatings with NO-catalytic bioactivity can inhibit collagen-induced platelet activation and adhesion, proliferation, and migration of arterial smooth muscle cells through the cGMP signaling pathways. Studies showed good anti-thrombogenic properties in extracorporeal circuits [ 61 , 72 ]. Moreover, stents implanted in rabbits with this coating showed improved endothelial mimetic microenvironment, stronger recovery to the endothelium, and had less restenosis and thrombosis after 4 weeks [ 73 ].…”

“…The main disadvantage with NO is the fact that its storage cannot exceed 4 weeks. This can be a problem in long-term ECLS runs [ 61 , 72 ]. So far, NO-coatings have not been used commercially.…”

DNase I functional microgels for neutrophil extracellular trap disruption

“…The white powder of the purified product was obtained by washing the solids with 20 mL anhydrous THF (×3) and 20 mL DEE (×1) and drying under reduced pressure (yield 27 g, 82%). The structural analysis of the product was performed by 1 H NMR recorded on a Bruker Avance III-300 FT-NMR spectrometer (Bruker Corporation, Billerica, MA, USA) at 300 MHz using deuterium oxide as a solvent. 1 2.2.3 Synthesis of p(HPMA-co-CBMAA) microgels.…”

“…The structural analysis of the product was performed by 1 H NMR recorded on a Bruker Avance III-300 FT-NMR spectrometer (Bruker Corporation, Billerica, MA, USA) at 300 MHz using deuterium oxide as a solvent. 1 2.2.3 Synthesis of p(HPMA-co-CBMAA) microgels. The microgels were prepared via an inverse miniemulsion polymerization using N,N′-methylenebis(acrylamide) (MBAA) crosslinker.…”

“…The morbidity arising from the material-induced thrombosis along with the risk of bacterial colonization and subsequent infections limits the biomedical applications of blood-contacting materials such as extracorporeal membrane oxygenators (ECMOs) used in artificial lungs-supporting systems. 1,2 The lack of active thrombosis-and pathogenesis-resistance on the artificial surfaces promotes adverse interactions with blood components. The most important of these is the adsorption of proteins on the surfaces followed by the activation of platelets and subsequent inflammation, which triggers thrombus formation and complement activation.…”