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Spencer BL, Johnson MD, Wilhelm SK, Lautner-Csorba OD, Matich H, Lautner G, Fallon BP, Dann T, Gudex L, Langley M, Meyerhoff M, Potkay J, Bartlett R, Rojas-Pena A, Hirschl RB. A Pumpless Pediatric Artificial Lung Maintains Function for 72 h Without Systemic Anticoagulation Using the Nitric Oxide Surface Anticoagulation System. J Pediatr Surg 2024; 59:103-108. [PMID: 37858393 PMCID: PMC10843264 DOI: 10.1016/j.jpedsurg.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/06/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Children with end-stage lung disease are commonly managed with extracorporeal life support (ECLS) as a bridge to lung transplantation. A pumpless artificial lung (MLung) is a portable alternative to ECLS and it allows for ambulation. Both ECLS and pumpless artificial lungs require systemic anticoagulation which is associated with hemorrhagic complications. We tested the MLung with a novel Nitric Oxide (NO) Surface Anticoagulation (NOSA) system, to provide local anticoagulation for 72 h of support in a pediatric-size ovine model. METHODS Four mini sheep underwent thoracotomy and cannulation of the pulmonary artery (inflow) and left atrium (outflow), recovered and were monitored for 72hr. The circuit tubing and connectors were coated with the combination of an NO donor (diazeniumdiolated dibutylhexanediamine; DBHD-N2O2) and argatroban. The animals were connected to the MLung and 100 ppm of NO was added to the sweep gas. Systemic hemodynamics, blood chemistry, blood gases, and methemoglobin were collected. RESULTS Mean device flow was 836 ± 121 mL/min. Device outlet saturation was 97 ± 4%. Pressure drop across the lung was 3.5 ± 1.5 mmHg and resistance was 4.3 ± 1.7 mmHg/L/min. Activated clotting time averaged 170 ± 45s. Methemoglobin was 2.9 ± 0.8%. Platelets declined from 590 ± 101 at baseline to 160 ± 90 at 72 h. NO flux (x10-10 mol/min/cm2) of the NOSA circuit averaged 2.8 ± 0.6 (before study) and 1.9 ± 0.1 (72 h) and across the MLung 18 ± 3 NO flux was delivered. CONCLUSION The MLung is a more portable form of ECLS that demonstrates effective gas exchange for 72 h without hemodynamic changes. Additionally, the NOSA system successfully maintained local anticoagulation without evidence of systemic effects.
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Affiliation(s)
- Brianna L Spencer
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II, Ann Arbor, MI 48109, United States.
| | - Matthew D Johnson
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II, Ann Arbor, MI 48109, United States
| | - Spencer K Wilhelm
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II, Ann Arbor, MI 48109, United States
| | - Orsolya D Lautner-Csorba
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II, Ann Arbor, MI 48109, United States
| | - Hannah Matich
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II, Ann Arbor, MI 48109, United States
| | - Gergely Lautner
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II, Ann Arbor, MI 48109, United States
| | - Brian P Fallon
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II, Ann Arbor, MI 48109, United States
| | - Tyler Dann
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II, Ann Arbor, MI 48109, United States
| | - Leah Gudex
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II, Ann Arbor, MI 48109, United States
| | - Mark Langley
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II, Ann Arbor, MI 48109, United States
| | - Mark Meyerhoff
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Joseph Potkay
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II, Ann Arbor, MI 48109, United States; VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Robert Bartlett
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II, Ann Arbor, MI 48109, United States
| | - Alvaro Rojas-Pena
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II, Ann Arbor, MI 48109, United States
| | - Ronald B Hirschl
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II, Ann Arbor, MI 48109, United States; Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, 1540 E Hospital Dr, Ann Arbor, MI 48109, United States
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2
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Zhao CY, Sheng KJ, Bao T, Shi T, Liu PN, Yan Y, Zheng XL. Commercial and novel anticoagulant ECMO coatings: a review. J Mater Chem B 2023. [PMID: 37183615 DOI: 10.1039/d3tb00471f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is an invasive and last-resort treatment for circulatory and respiratory failure. Prolonged ECMO support can disrupt the coagulation and anticoagulation systems in a patient, leading to adverse consequences, such as bleeding and thrombosis. To address this problem, anticoagulation coatings have been developed for use in ECMO circuits. This article reviews commonly used commercial and novel anticoagulant coatings developed in recent years and proposes a new classification of coatings based on the current state. While commercial coatings have been used clinically for decades, this review focuses on comparing the effectiveness and stability of coatings to support clinical selections. Furthermore, novel anticoagulation coatings often involve complex mechanisms and elaborate design strategies, and this review summarises representative studies on mainstream anticoagulation coatings to provide a point of reference for future studies.
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Affiliation(s)
- Chang-Ying Zhao
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
| | - Kang-Jia Sheng
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Tao Bao
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Tao Shi
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
| | - Pei-Nan Liu
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Yang Yan
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
| | - Xing-Long Zheng
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
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3
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Roberts TR, Harea GT, Zang Y, Devine RP, Maffe P, Handa H, Batchinsky AI. A dual-action nitric oxide-releasing slippery surface for extracorporeal organ support: Dynamic in vitro hemocompatibility evaluation. J Biomed Mater Res B Appl Biomater 2023; 111:923-932. [PMID: 36404401 DOI: 10.1002/jbm.b.35202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/01/2022] [Accepted: 11/13/2022] [Indexed: 11/22/2022]
Abstract
Numerous biomaterials have been developed for application in blood-contacting medical devices to prevent thrombosis; however, few materials have been applied to full-scale devices and evaluated for hemocompatibility under clinical blood flow conditions. We applied a dual-action slippery liquid-infused (LI) nitric oxide (NO)-releasing material modification (LINO) to full-scale blood circulation tubing for extracorporeal lung support and evaluated the tubing ex vivo using swine whole blood circulated for 6 h at a clinically relevant flow. LINO tubing was compared to unmodified tubing (CTRL) and isolated LI and NO-releasing modifications (n = 9/group). The primary objective was to evaluate safety and blood compatibility of this approach, prior to progression to in vivo testing of efficacy in animal models. The secondary objective was to evaluate coagulation outcomes relevant to hemocompatibility. No untoward effects of the coating, such as elevated methemoglobin fraction, were observed. Additionally, LINO delayed platelet loss until 6 h versus the reduction in platelet count in CTRL at 3 h. At 6 h, LINO significantly reduced the concentration of platelets in an activated P-selectin expressing state versus CTRL (32 ± 1% decrease, p = .02). Blood clot deposition was significantly reduced on LINO blood pumps (p = .007) and numerically reduced on tubing versus CTRL. Following blood exposure, LINO tubing continued to produce a measurable NO-flux (0.20 ± 0.06 × 10-10 mol cm-2 min-1 ). LINO is a potential solution to reduce circuit-related bleeding and clotting during extracorporeal organ support, pending future extended testing in vivo using full-scale extracorporeal lung support devices.
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Affiliation(s)
- Teryn R Roberts
- Autonomous Reanimation and Evacuation Research Program, The Geneva Foundation, San Antonio, Texas, USA
| | - George T Harea
- Autonomous Reanimation and Evacuation Research Program, The Geneva Foundation, San Antonio, Texas, USA
| | - Yanyi Zang
- Autonomous Reanimation and Evacuation Research Program, The Geneva Foundation, San Antonio, Texas, USA
| | - Ryan P Devine
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia, USA
| | - Patrick Maffe
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia, USA
| | - Hitesh Handa
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia, USA.,Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, University of Georgia, Athens, Georgia, USA
| | - Andriy I Batchinsky
- Autonomous Reanimation and Evacuation Research Program, The Geneva Foundation, San Antonio, Texas, USA
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4
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Spencer BL, Mychaliska GB. Updates in Neonatal Extracorporeal Membrane Oxygenation and the Artificial Placenta. Clin Perinatol 2022; 49:873-891. [PMID: 36328605 DOI: 10.1016/j.clp.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Extracorporeal life support, initially performed in neonates, is now commonly used for both pediatric and adult patients requiring pulmonary and/or cardiac support. Data suggests the clinical feasibility of Extracorporeal Membrane Oxygenation for premature infants (29-33 weeks estimated gestational age [EGA]). For extremely premature infants less than 28 weeks EGA, an artificial placenta has been developed to recreate the fetal environment. This approach is investigational but clinical translation is promising. In this article, we discuss the current state and advances in neonatal and "preemie Extracorporeal Membrane Oxygenation" and the development of an artificial placenta and its potential use in extremely premature infants.
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Affiliation(s)
- Brianna L Spencer
- Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - George B Mychaliska
- Section of Pediatric Surgery, Department of Surgery, Fetal Diagnosis and Treatment Center, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
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5
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Spencer BL, Mychaliska GB. Milestones for clinical translation of the artificial placenta. Semin Fetal Neonatal Med 2022; 27:101408. [PMID: 36437184 DOI: 10.1016/j.siny.2022.101408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Despite significant advances in the treatment of prematurity, premature birth results in significant mortality and morbidity. In particular, extremely low gestational age newborns (ELGANs) defined as <28 weeks estimated gestational age (EGA) suffer from disproportionate mortality and morbidity. A radical paradigm shift in the treatment of prematurity is to recreate fetal physiology using an extracorporeal VV-ECLS artificial placenta (AP) or an AV-ECLS artificial womb (AW). Over the past 15 years, tremendous advances have been made in the laboratory confirming long-term support and organ protection and ongoing development. The major milestones to clinical application are miniaturization, anticoagulation, clinical risk stratification, specialized critical care protocols, a regulatory path and a strategy and platform to translate technology to the bedside. Currently, several groups are addressing the remaining milestones for clinical translation.
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Affiliation(s)
- Brianna L Spencer
- Department of Surgery, University of Michigan, 2101 Taubman Center 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
| | - George B Mychaliska
- Section of Pediatric Surgery, Department of Surgery, Fetal Diagnosis and Treatment Center, C.S. Mott Children's Hospital, 1540 E Hospital Dr, Ann Arbor, MI, 48109, USA.
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6
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Roberts TR, Garren MRS, Wilson SN, Handa H, Batchinsky AI. Development and In Vitro Whole Blood Hemocompatibility Screening of Endothelium-Mimetic Multifunctional Coatings. ACS APPLIED BIO MATERIALS 2022; 5:2212-2223. [PMID: 35404571 DOI: 10.1021/acsabm.2c00073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Multifunctional antithrombotic surface modifications for blood-contacting medical devices have emerged as a solution for foreign surface-mediated coagulation disturbance. Herein, we have developed and evaluated an endothelium-inspired strategy to reduce the thrombogenicity of medical plastics by imparting nitric oxide (NO) elution and heparin immobilization on the material surface. This dual-action approach (NO+Hep) was applied to polyethylene terephthalate (PET) blood incubation vials and compared to isolated modifications. Vials were characterized to evaluate NO surface flux as well as heparin density and activity. Hemocompatibility was assessed in vitro using whole blood from human donors. Compared to unmodified surfaces, blood incubated in the NO+Hep vials exhibited reduced platelet aggregation (15% decrease AUC, p = 0.040) and prolonged plasma clotting times (aPTT = 147% increase, p < 0.0001, prothrombin time = 5% increase, p = 0.0002). Prolongation of thromboelastography reaction time and elevated antifactor Xa levels in blood from NO+Hep versus PET vials suggests some heparin leaching from the vial surface, confirmed by post-blood incubation heparin density assessment. Results suggest NO+Hep surface modification is a promising approach for blood-contacting plastics; however, careful tuning of NO flux and heparin stabilization are essential and require assessment using human blood as performed here.
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Affiliation(s)
- Teryn R Roberts
- Autonomous Reanimation and Evacuation Research Program, The Geneva Foundation, 2509 Kennedy Circle Bldg 125, San Antonio, Texas 78235, United States
| | - Mark R S Garren
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Sarah N Wilson
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Hitesh Handa
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States.,Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Andriy I Batchinsky
- Autonomous Reanimation and Evacuation Research Program, The Geneva Foundation, 2509 Kennedy Circle Bldg 125, San Antonio, Texas 78235, United States
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7
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Griffin L, Douglass M, Goudie M, Hopkins SP, Schmiedt C, Handa H. Improved Polymer Hemocompatibility for Blood-Contacting Applications via S-Nitrosoglutathione Impregnation. ACS APPLIED MATERIALS & INTERFACES 2022; 14:11116-11123. [PMID: 35225600 PMCID: PMC9793915 DOI: 10.1021/acsami.1c24557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Blood-contacting medical devices (BCMDs) are inevitably challenged by thrombi formation, leading to occlusion of flow and device failure. Ideal BCMDs seek to mimic the intrinsic antithrombotic properties of the human vasculature to locally prevent thrombotic complications, negating the need for systemic anticoagulation. An emerging category of BCMD technology utilizes nitric oxide (NO) as a hemocompatible agent, as the vasculature's endothelial layer naturally releases NO to inhibit platelet activation and consumption. In this paper, we report for the first time the novel impregnation of S-nitrosoglutathione (GSNO) into polymeric poly(vinyl chloride) (PVC) tubing via an optimized solvent-swelling method. Material testing revealed an optimized GSNO-PVC material that had adequate GSNO loading to achieve NO flux values within the physiological endothelial NO flux range for a 4 h period. Through in vitro hemocompatibility testing, the optimized material was deemed nonhemolytic (hemolytic index <2%) and capable of reducing platelet activation, suggesting that the material is suitable for contact with whole blood. Furthermore, an in vivo 4 h extracorporeal circulation (ECC) rabbit thrombogenicity model confirmed the blood biocompatibility of the optimized GSNO-PVC. Platelet count remained near 100% for the novel GSNO-impregnated PVC loops (1 h, 91.08 ± 6.27%; 2 h, 95.68 ± 0.61%; 3 h, 97.56 ± 8.59%; 4 h, 95.11 ± 8.30%). In contrast, unmodified PVC ECC loops occluded shortly after the 2 h time point and viable platelet counts quickly diminished (1 h, 85.67 ± 12.62%; 2 h, 54.46 ± 10.53%; 3 h, n/a; 4 h, n/a). The blood clots for GSNO-PVC loops (190.73 ± 72.46 mg) compared to those of unmodified PVC loops (866.50 ± 197.98 mg) were significantly smaller (p < 0.01). The results presented in this paper recommend further investigation in long-term animal models and suggest that GSNO-PVC has the potential to serve as an alternative to systemic anticoagulation in BCMD applications.
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Affiliation(s)
- Lauren Griffin
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
| | - Megan Douglass
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
| | - Marcus Goudie
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
| | - Sean P Hopkins
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
| | - Chad Schmiedt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
| | - Hitesh Handa
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
- Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
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8
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Zhang M, Pauls JP, Bartnikowski N, Haymet AB, Chan CHH, Suen JY, Schneider B, Ki KK, Whittaker AK, Dargusch MS, Fraser JF. Anti-thrombogenic Surface Coatings for Extracorporeal Membrane Oxygenation: A Narrative Review. ACS Biomater Sci Eng 2021; 7:4402-4419. [PMID: 34436868 DOI: 10.1021/acsbiomaterials.1c00758] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is used in critical care to manage patients with severe respiratory and cardiac failure. ECMO brings blood from a critically ill patient into contact with a non-endothelialized circuit which can cause clotting and bleeding simultaneously in this population. Continuous systemic anticoagulation is needed during ECMO. The membrane oxygenator, which is a critical component of the extracorporeal circuit, is prone to significant thrombus formation due to its large surface area and areas of low, turbulent, and stagnant flow. Various surface coatings, including but not limited to heparin, albumin, poly(ethylene glycol), phosphorylcholine, and poly(2-methoxyethyl acrylate), have been developed to reduce thrombus formation during ECMO. The present work provides an up-to-date overview of anti-thrombogenic surface coatings for ECMO, including both commercial coatings and those under development. The focus is placed on the coatings being developed for oxygenators. Overall, zwitterionic polymer coatings, nitric oxide (NO)-releasing coatings, and lubricant-infused coatings have attracted more attention than other coatings and showed some improvement in in vitro and in vivo anti-thrombogenic effects. However, most studies lacked standard hemocompatibility assessment and comparison studies with current clinically used coatings, either heparin coatings or nonheparin coatings. Moreover, this review identifies that further investigation on the thrombo-resistance, stability and durability of coatings under rated flow conditions and the effects of coatings on the function of oxygenators (pressure drop and gas transfer) are needed. Therefore, extensive further development is required before these new coatings can be used in the clinic.
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Affiliation(s)
- Meili Zhang
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia.,School of Mechanical and Mining Engineering, The University of Queensland, Brisbane, Queensland 4072,Australia
| | - Jo P Pauls
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia.,School of Engineering and Built Environment, Griffith University, Southport, Queensland 4222, Australia
| | - Nicole Bartnikowski
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia.,School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland 4000, Australia
| | - Andrew B Haymet
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia
| | - Chris H H Chan
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia.,School of Engineering and Built Environment, Griffith University, Southport, Queensland 4222, Australia
| | - Jacky Y Suen
- Scientific and Translational Research Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Bailey Schneider
- Scientific and Translational Research Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia
| | - Katrina K Ki
- Scientific and Translational Research Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia
| | - Andrew K Whittaker
- Australian Institute for Bioengineering and Nanotechnology and ARC Center of Excellence in Convergent Bio-Nano Science and Technology, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Matthew S Dargusch
- School of Mechanical and Mining Engineering, The University of Queensland, Brisbane, Queensland 4072,Australia
| | - John F Fraser
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia.,Scientific and Translational Research Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland 4072, Australia.,School of Medicine, Griffith University, Southport, Queensland 4222, Australia
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