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Prolonged Extracorporeal Membrane Oxygenation Without Systemic Anticoagulation in Sheep.

Zahra Mahdieh1, Alex Meng1,2, Brian Y Chang1,3

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|March 5, 2026
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Summary

This study shows a new extracorporeal membrane oxygenation (ECMO) system may reduce blood clots and bleeding without anticoagulation. The InFlo MOBYBOX demonstrated minimal thrombosis and hemolysis in low-flow conditions.

Keywords:
AnticoagulantCoagulationECMOExtracorporeal membrane oxygenatorLow flowOxygenator

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Area of Science:

  • Biomedical Engineering
  • Cardiovascular Research
  • Medical Device Innovation

Background:

  • Clinically significant bleeding is a major complication of extracorporeal membrane oxygenation (ECMO), affecting over 40% of patients.
  • Systemic anticoagulation, while necessary to prevent circuit thrombosis, increases bleeding risk.
  • Existing ECMO systems face challenges in balancing anticoagulation needs with bleeding complications.

Purpose of the Study:

  • To evaluate the InFlo MOBYBOX ECMO system's ability to mitigate thrombosis and hemolysis.
  • To assess if the system's multimodal design can reduce reliance on systemic anticoagulation.
  • To investigate performance under low-flow conditions, a high-risk scenario for coagulation.

Main Methods:

  • A seven-day ovine study using InFlo MOBYBOX ECMO systems with a biopassive hydrophilic coating.
  • Continuous low-flow conditions (1.8-2.2 L/min) were maintained without systemic anticoagulants.
  • Evaluated oxygen delivery, carbon dioxide removal, clotting, hematology, and organ damage.

Main Results:

  • The InFlo MOBYBOX showed minimal clot coverage (2.3% ± 3.1%) in the inlet helical pathway.
  • No device degradation, systemic thrombosis, or end-organ damage was observed.
  • Hematologic indices remained stable, hemolysis was absent (confirmed by plasma-free hemoglobin), and oxygen transfer was preserved.

Conclusions:

  • The InFlo MOBYBOX shows potential for anticoagulant-free low-flow ECMO support.
  • The multimodal approach, combining optimized fluidics and surface coating, may enhance safety.
  • Further research could advance extracorporeal therapies by reducing thrombosis and hemolysis.