Technical Advances in the Field of ECMO

Betit, Peter

doi:10.4187/respcare.06320

Cited by 48 publications

(44 citation statements)

References 56 publications

(66 reference statements)

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“…Respiratory assist devices are commanding increasing attention as a means to treat severe hypoxia in patients suffering from ARDS associated with traumatic injuries as well as a number of pulmonary infections, most notably swine flu and COVID-19. Application of ECMO in these patient populations continues to advance as the technology has overcome many challenges associated with clotting and plasma leakage [ 41 ]. However, significant barriers to expanded use of ECMO technology remain, particularly associated with the complexity of the blood circuit and anticoagulant administration.…”

Section: Discussionmentioning

confidence: 99%

Toward Development of a Higher Flow Rate Hemocompatible Biomimetic Microfluidic Blood Oxygenator

et al. 2021

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The recent emergence of microfluidic extracorporeal lung support technologies presents an opportunity to achieve high gas transfer efficiency and improved hemocompatibility relative to the current standard of care in extracorporeal membrane oxygenation (ECMO). However, a critical challenge in the field is the ability to scale these devices to clinically relevant blood flow rates, in part because the typically very low blood flow in a single layer of a microfluidic oxygenator device requires stacking of a logistically challenging number of layers. We have developed biomimetic microfluidic oxygenators for the past decade and report here on the development of a high-flow (30 mL/min) single-layer prototype, scalable to larger structures via stacking and assembly with blood distribution manifolds. Microfluidic oxygenators were designed with biomimetic in-layer blood distribution manifolds and arrays of parallel transfer channels, and were fabricated using high precision machined durable metal master molds and microreplication with silicone films, resulting in large area gas transfer devices. Oxygen transfer was evaluated by flowing 100% O2 at 100 mL/min and blood at 0–30 mL/min while monitoring increases in O2 partial pressures in the blood. This design resulted in an oxygen saturation increase from 65% to 95% at 20 mL/min and operation up to 30 mL/min in multiple devices, the highest value yet recorded in a single layer microfluidic device. In addition to evaluation of the device for blood oxygenation, a 6-h in vitro hemocompatibility test was conducted on devices (n = 5) at a 25 mL/min blood flow rate with heparinized swine donor blood against control circuits (n = 3). Initial hemocompatibility results indicate that this technology has the potential to benefit future applications in extracorporeal lung support technologies for acute lung injury.

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Section: Discussionmentioning

confidence: 99%

Toward Development of a Higher Flow Rate Hemocompatible Biomimetic Microfluidic Blood Oxygenator

et al. 2021

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“…Extracorporeal membrane oxygenation (ECMO) is increasingly used to treat cardiopulmonary failure in critically ill patients with promising results [1]. Several technological advances, including pump design, more biocompatible cannulas, and larger surface oxygenators, have enabled longer duration of ECMO use and the extension of ECMO in-dications to a larger group of patients, which have contributed to the development of high-volume centers, new ECMO programs and particular expertise in ECMO management [2]. With the increasing number of treated patients, most patients are percutaneously cannulated [3]; although this is an invasive approach that requires adequate training, the rate of related complications is relatively low and the impact of such complications on mortality remains limited [4].…”

Section: Introductionmentioning

confidence: 99%

Early Findings after Implementation of Veno-Arteriovenous ECMO: A Multicenter European Experience

et al. 2021

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Extracorporeal membrane oxygenation (ECMO) is increasingly used to treat cardiopulmonary failure in critically ill patients. Peripheral cannulation may be complicated by a persistent low cardiac output in case of veno-venous cannulation (VV-ECMO) or by differential hypoxia (e.g., lower PaO2 in the upper than in the lower body) in case of veno-arterial cannulation (VA-ECMO) and severe impairment of pulmonary function associated with cardiac recovery. The treatment of such complications remains challenging. We report the early effects of the use of veno-arterial-venous (V-AV) ECMO in this setting. Methods: Retrospective analysis including patients from five different European ECMO centers (January 2013 to December 2016) who required V-AV ECMO. We collected demographic data as well as comorbidities and ECMO characteristics, hemodynamics, and arterial blood gas values before and immediately after (i.e., within 2 h) V-AV implementation. Results: A total of 32 patients (age 53 (interquartiles, IQRs: 31–59) years) were identified: 16 were initially supported with VA-ECMO and 16 with VV-ECMO. The median time to V-AV conversion was 2 (1–5) days. After V-AV implantation, heart rate and norepinephrine dose significantly decreased, while PaO2 and SaO2 significantly increased compared to baseline values. Lactate levels significantly decreased from 3.9 (2.3–7.1) to 2.8 (1.4–4.4) mmol/L (p = 0.048). A significant increase in the overall ECMO blood flow (from 4.5 (3.8–5.0) to 4.9 (4.3–5.9) L/min; p < 0.01) was observed, with 3.0 (2.5–3.2) L/min for the arterial and 2.8 (2.1–3.6) L/min for the venous return flows. Conclusions: In ECMO patients with differential hypoxia or persistently low cardiac output syndrome, V-AV conversion was associated with improvement in some hemodynamic and respiratory parameters. A significant increase in the overall ECMO blood flow was also observed, with similar flow distributed into the arterial and venous return cannulas.

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“…There, oxygen streams through the inner lumen of the membrane fibers and diffuses through the membrane into the blood, while carbon dioxide is removed [ 3 ]. Various membranes can be used for gas exchange [ 4 ]. While polypropylene (PP) has good gas permeability properties, plasma-leakage remains a major limitation for long-term use [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

A Novel C1-Esterase Inhibitor Oxygenator Coating Prevents FXII Activation in Human Blood

Gerling¹,

Ölschläger²,

Avci‐Adali³

et al. 2020

Biomolecules

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The limited hemocompatibility of currently used oxygenator membranes prevents long-term use of artificial lungs in patients with lung failure. To improve hemocompatibility, we developed a novel covalent C1-esterase inhibitor (C1-INH) coating. Besides complement inhibition, C1-INH also prevents FXII activation, a very early event of contact phase activation at the crossroads of coagulation and inflammation. Covalently coated heparin, as the current anticoagulation gold standard, served as control. Additionally, a combination of both coatings (C1-INH/heparin) was established. The coatings were tested for their hemocompatibility by dynamic incubation with freshly drawn human whole blood. The analysis of various blood and plasma parameters revealed that C1-INH-containing coatings were able to markedly reduce FXIIa activity compared to heparin coating. Combined C1-INH/heparin coatings yielded similarly low levels of thrombin-antithrombin III complex formation as heparin coating. In particular, adhesion of monocytes and platelets as well as the diminished formation of fibrin networks were observed for combined coatings. We could show for the first time that a covalent coating with complement inhibitor C1-INH was able to ameliorate hemocompatibility. Thus, the early inhibition of the coagulation cascade is likely to have far-reaching consequences for the other cross-reacting plasma protein pathways.

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Technical Advances in the Field of ECMO

Cited by 48 publications

References 56 publications

Toward Development of a Higher Flow Rate Hemocompatible Biomimetic Microfluidic Blood Oxygenator

Toward Development of a Higher Flow Rate Hemocompatible Biomimetic Microfluidic Blood Oxygenator

Early Findings after Implementation of Veno-Arteriovenous ECMO: A Multicenter European Experience

A Novel C1-Esterase Inhibitor Oxygenator Coating Prevents FXII Activation in Human Blood

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