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Surface-heparinized neonatal ECMO circuit--an experimental animal study.
B Frenckner1, H Ehrén, K Palmér
1Department of Pediatric Surgery, St Göran's Hospital, Stockholm, Sweden.
Perfusion
|January 1, 1992
Summary
The Carmeda Bioactive Surface shows promise in preventing clot formation in neonatal extracorporeal membrane oxygenation (ECMO) circuits. This innovation may reduce the need for systemic heparinization in neonates undergoing ECMO therapy.
Area of Science:
- Biomedical Engineering
- Cardiovascular Research
- Neonatal Intensive Care
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support system used for neonates with severe cardiorespiratory failure.
- Clot formation within ECMO circuits is a significant complication, often necessitating systemic anticoagulation with heparin.
- Heparinization carries risks, particularly in neonates, highlighting the need for alternative strategies to improve circuit hemocompatibility.
Purpose of the Study:
- To evaluate the efficacy of the Carmeda Bioactive Surface in preventing thrombosis in a neonatal ECMO circuit.
- To determine the optimal heparinization strategy when using the Carmeda Bioactive Surface in neonatal ECMO.
- To explore the potential for reducing heparin requirements through advanced circuit design and thrombo-resistant surfaces.
Main Methods:
- Seven experiments were conducted using a Terumo Capiox oxygenator in a neonatal ECMO circuit model.
- Mongrel dogs were subjected to veno-arterial bypass at a low flow rate (200 ml/min).
- Different heparinization protocols were tested, ranging from no heparin to low-dose continuous infusion and bolus injections, to assess clot formation.
Main Results:
- Without heparin, the ECMO circuit occluded rapidly due to clot formation.
- A very low heparin infusion (10 IUxkg-1xh-1) allowed for sustained extracorporeal blood flow but still resulted in some oxygenator clotting.
- A combination of a small heparin bolus (20 IU/kg) and low continuous infusion (20 IUxkg-1xh-1) led to negligible clotting in the ECMO circuit with the Carmeda surface.
Conclusions:
- The Carmeda Bioactive Surface demonstrates significant potential in mitigating clot formation within neonatal ECMO circuits.
- Optimizing device hemodynamics alongside thrombo-resistant surfaces may substantially decrease the reliance on systemic heparinization in neonatal ECMO.
- Further development combining improved circuit design and advanced biomaterials could enhance safety and efficacy of neonatal ECMO.