The effects of nitric oxide on coagulation and inflammation in ex-vivo models of extracorporeal membrane oxygenation and cardiopulmonary bypass

Extracorporeal life support (ECLS) has extensive applications in managing patients with acute cardiac and pulmonary failure. Two primary modalities of ECLS, cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO), include several similarities in their composition, complications,...

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Published in:	Artificial organs Vol. 47; no. 10; pp. 1581 - 1591
Main Authors:	Malfertheiner, Maximilian V, Ashlen, Garrett, Margaret, Passmore, Haymet, Andrew B, Richard, Webb I, von Bahr, Viktor, Millar, Jonathan E, Schneider, Bailey A, Obonyo, Nchafatso G, Debra, Black, Mahe, Bouquet, Nicole, Bartnikowski, Suen, Jacky Y, Fraser, John F
Format:	Journal Article
Language:	English
Published:	United States Wiley Subscription Services, Inc 01-10-2023
Subjects:	Anticoagulants Blood clots Coagulation Complications Extracorporeal membrane oxygenation Heart surgery Heparin Inflammation Medicin och hälsovetenskap Membranes Morbidity Nitric oxide Oxygenation Platelets Thrombosis ECMO nitric oxide Extracorporeal Membrane Oxygenation thrombosis CPB anticoagulation cardiopulmonary bypass mechanical circulatory support Extracorporeal Life Support
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Summary:	Extracorporeal life support (ECLS) has extensive applications in managing patients with acute cardiac and pulmonary failure. Two primary modalities of ECLS, cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO), include several similarities in their composition, complications, and patient outcomes. Both CPB and ECMO pose a high risk of thrombus formation and platelet activation due to the large surface area of the devices and bleeding due to system anticoagulation. Therefore, novel methods of anticoagulation are needed to reduce the morbidity and mortality associated with extracorporeal support. Nitric oxide has potent antiplatelet properties and presents a promising alternative or addition to anticoagulation with heparin during extracorporeal support. We developed two ex-vivo models of CPB and ECMO to investigate nitric oxide (NO) effects on anticoagulation and inflammation in these systems. Sole addition of NO as an anticoagulant was not successful in preventing thrombus formation in the ex vivo setups, therefore a combination of low level heparin with NO was used. Antiplatelet effects were observed in the ex vivo ECMO model when nitric oxide was delivered at 80 PPM. Platelet count was preserved after 480 minutes when nitric oxide was delivered at 30 PPM. Combined delivery of nitric oxide and heparin did not improve haemocompatibility in either ex vivo model of CPB and ECMO. Anti-inflammatory effects of NO in ECMO systems have to be evaluated further.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0160-564X 1525-1594 1525-1594
DOI:	10.1111/aor.14608