Thrombotic Complications during Interventional Lung Assist: Case Series

Kim, Eun Jung; Cho, Woo Hyun; Ahn, Eun Young; Ryu, Dae Gon; Lee, Seung Eun; Jeon, Doo Soo; Kim, Yun Seong; Son, Bong Soo

doi:10.4046/trd.2015.78.1.18

Cited by 3 publications

(3 citation statements)

References 10 publications

(41 reference statements)

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“…While this improves the usability of the device, it also favors an uneven flow distribution during operation. While in the lower corner shortcutting of the flow between inlet and outlet is very likely, in the upper corner the risk of stagnated flow and thrombosis is elevated, especially under low flow conditions (< 1.5 L/min) 37 , 38 . Indeed, initial experiences with the iLA device indicated that areas of the flow chambers with low or stagnant flow were precisely the areas in which the majority of thrombi were found 34 .…”

Section: Introductionmentioning

confidence: 99%

TPMS-based membrane lung with locally-modified permeabilities for optimal flow distribution

Hesselmann

Halwes

Bongartz

et al. 2022

Sci Rep

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Membrane lungs consist of thousands of hollow fiber membranes packed together as a bundle. The devices often suffer from complications because of non-uniform flow through the membrane bundle, including regions of both excessively high flow and stagnant flow. Here, we present a proof-of-concept design for a membrane lung containing a membrane module based on triply periodic minimal surfaces (TPMS). By warping the original TPMS geometries, the local permeability within any region of the module could be raised or lowered, allowing for the tailoring of the blood flow distribution through the device. By creating an iterative optimization scheme for determining the distribution of streamwise permeability inside a computational porous domain, the desired form of a lattice of TPMS elements was determined via simulation. This desired form was translated into a computer-aided design (CAD) model for a prototype device. The device was then produced via additive manufacturing in order to test the novel design against an industry-standard predicate device. Flow distribution was verifiably homogenized and residence time reduced, promising a more efficient performance and increased resistance to thrombosis. This work shows the promising extent to which TPMS can serve as a new building block for exchange processes in medical devices.

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Section: Introductionmentioning

confidence: 99%

TPMS-based membrane lung with locally-modified permeabilities for optimal flow distribution

Hesselmann

Halwes

Bongartz

et al. 2022

Sci Rep

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“…This lower flow allows the use of smaller catheters and increases the efficiency of devices for extracorporeal CO 2 removal. However, as blood flow decreases, blood components experience relative stasis that can increase thrombin generation, platelet activation, and clot formation 9 …”

Section: Introductionmentioning

confidence: 99%

“…However, as blood flow decreases, blood components experience relative stasis that can increase thrombin generation, platelet activation, and clot formation. 9 Laboratory studies document that areas of low-flow velocity increase thrombin generation. 10,11 In such lowflow areas (e.g., <0.3 L/min), significantly fewer clot initiation factors are required to trigger clot formation than in higher-flow areas.…”

Section: Introductionmentioning

confidence: 99%

Regional blood acidification inhibits coagulation during extracorporeal carbon dioxide removal (ECCO₂R)

et al. 2022

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Background: Consumption of platelets and coagulation factors during extracorporeal carbon dioxide removal (ECCO 2 R) increases bleeding complications and associated mortality. Regional infusion of lactic acid enhances ECCO 2 R by shifting the chemical equilibrium from bicarbonate to carbon dioxide. Our goal was to test if regional blood acidification during ECCO 2 R inhibits platelet function and coagulation.Methods: An ECCO 2 R system containing a hemofilter circulated blood at 0.25 L/min in eight healthy ewes (Ovis aries) for 36 h. Three of the sheep received ECCO 2 R with no recirculation compared to five sheep that received ECCO 2 R plus 12 h of regional blood acidification via the hemofilter, placed upstream from the oxygenator, into which 4.4 M lactic acid was infused. Blood gases, platelet count and function, thromboelastography, coagulation-factor activity, and von Willebrand factor activity (vWF:Ag) were measured at baseline, at start of lactic acid infusion, and after 36 h of extracorporeal circulation.Results: Twelve hours of regional acid infusion significantly inhibited platelet aggregation response to adenosine diphosphate; vWF; and platelet expression of P-selectin compared to control. It also significantly reduced consumption of fibrinogen and of coagulation factors V, VII, IX, compared to control. Conclusions: Regional acidification reduces platelet activation and vitamin-Kdependent coagulation-factor consumption during ECCO 2 R. This is the first report of a simple method that may enhance effective anticoagulation for ECCO 2 R.

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Extracorporeal carbon dioxide removal (ECCO2R) in respiratory deficiency and current investigations on its improvement: a review

Manap

Wahab

2016

J Artif Organs

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The implementation of extracorporeal carbon dioxide removal (ECCOR) as one of the extracorporeal life support system is getting more attention today. Thus, the objectives of this paper are to study the clinical practice of commercial ECCOR system, current trend of its development and also the perspective on future improvement that can be done to the existing ECCOR system. The strength of this article lies in its review scope, which focuses on the commercial ECCOR therapy in the market based on membrane lung and current investigation to improve the efficiency of the ECCOR system, in terms of surface modification by carbonic anhydrase (CA) immobilization technique and respiratory electrodialysis (R-ED). Our methodology approach involves the identification of relevant published literature from PubMed and Web of Sciences search engine using the terms Extracorporeal Carbon Dioxide Removal (ECCOR), Extracorporeal life support, by combining terms between ECCOR and CA and also ECCOR with R-ED. This identification only limits articles in English language. Overall, several commercial ECCOR systems are known and proven safe to be used in patients in terms of efficiency, safety and risk of complication. In addition, CA-modified hollow fiber for membrane lung and R-ED are proven to have good potential to be applied in conventional ECCOR design. The detailed technique and current progress on CA immobilization and R-ED development were also reviewed in this article.

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Thrombotic Complications during Interventional Lung Assist: Case Series

Cited by 3 publications

References 10 publications

TPMS-based membrane lung with locally-modified permeabilities for optimal flow distribution

TPMS-based membrane lung with locally-modified permeabilities for optimal flow distribution

Regional blood acidification inhibits coagulation during extracorporeal carbon dioxide removal (ECCO₂R)

Extracorporeal carbon dioxide removal (ECCO2R) in respiratory deficiency and current investigations on its improvement: a review

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Thrombotic Complications during Interventional Lung Assist: Case Series

Cited by 3 publications

References 10 publications

TPMS-based membrane lung with locally-modified permeabilities for optimal flow distribution

TPMS-based membrane lung with locally-modified permeabilities for optimal flow distribution

Regional blood acidification inhibits coagulation during extracorporeal carbon dioxide removal (ECCO2R)

Extracorporeal carbon dioxide removal (ECCO2R) in respiratory deficiency and current investigations on its improvement: a review

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Regional blood acidification inhibits coagulation during extracorporeal carbon dioxide removal (ECCO₂R)