Novel Surfaces in Extracorporeal Membrane Oxygenation Circuits

Area of Science:

• Biomaterials Science
• Hemostasis and Thrombosis
• Biomedical Engineering

Background:

• Maintaining the balance between anticoagulation and clotting is critical for hemostasis.
• Extracorporeal life support (ECLS) therapies pose challenges to physiologic hemostasis due to blood-surface interactions in artificial circuits.
• Systemic anticoagulation is essential in ECLS to mitigate the prothrombotic state induced by foreign materials.

Purpose of the Study:

• To review current and emerging surface modification strategies for extracorporeal circuits.
• To explore methods that can reduce or eliminate the need for systemic anticoagulation during ECLS.
• To enhance hemocompatibility by mimicking endothelial properties.

Main Methods:

• Classification of surface modifications into biomimetic, biopassive, and endothelialization categories.
• Review of anticoagulant agents like unfractionated heparin and direct thrombin inhibitors.
• Analysis of surface modifications involving changes in hydrophilicity/hydrophobicity and biomimetic coatings.

Main Results:

• Current trends involve direct thrombin inhibitors and surface modifications to improve hemocompatibility.
• Surface modifications aim to replicate endothelial functions, including anti-thrombotic and anti-inflammatory properties.
• Three main categories of surface modifications are identified: biomimetic, biopassive, and endothelialization.

Conclusions:

• Replicating the endothelium's properties is key to improving hemocompatibility in extracorporeal circuits.
• Novel surface modifications hold promise for obviating the need for systemic anticoagulation in ECLS.
• Advancements in biomaterials and surface engineering are crucial for safer ECLS therapies.