Abstract

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

Malfertheiner MV, Ashlen G, Margaret P, Haymet AB, Richard WI, von Bahr V, Millar JE, Schneider BA, Obonyo NG, Debra B, Mahe B, Nicole B, Suen JY, Fraser JF
Artif Organs. 2023;47

Permenent descriptor

BACKGROUND: 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. METHODES: We developed two ex-vivo models of CPB and ECMO to investigate nitric oxide (NO) effects on anticoagulation and inflammation in these systems. RESULTS: 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. CONCLUSION: 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.