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Imtiaz N, Poskus MD, Stoddard WA, Gaborski TR, Day SW. Empirical and Computational Evaluation of Hemolysis in a Microfluidic Extracorporeal Membrane Oxygenator Prototype. MICROMACHINES 2024; 15:790. [PMID: 38930760 PMCID: PMC11205701 DOI: 10.3390/mi15060790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
Microfluidic devices promise to overcome the limitations of conventional hemodialysis and oxygenation technologies by incorporating novel membranes with ultra-high permeability into portable devices with low blood volume. However, the characteristically small dimensions of these devices contribute to both non-physiologic shear that could damage blood components and laminar flow that inhibits transport. While many studies have been performed to empirically and computationally study hemolysis in medical devices, such as valves and blood pumps, little is known about blood damage in microfluidic devices. In this study, four variants of a representative microfluidic membrane-based oxygenator and two controls (positive and negative) are introduced, and computational models are used to predict hemolysis. The simulations were performed in ANSYS Fluent for nine shear stress-based parameter sets for the power law hemolysis model. We found that three of the nine tested parameters overpredict (5 to 10×) hemolysis compared to empirical experiments. However, three parameter sets demonstrated higher predictive accuracy for hemolysis values in devices characterized by low shear conditions, while another three parameter sets exhibited better performance for devices operating under higher shear conditions. Empirical testing of the devices in a recirculating loop revealed levels of hemolysis significantly lower (<2 ppm) than the hemolysis ranges observed in conventional oxygenators (>10 ppm). Evaluating the model's ability to predict hemolysis across diverse shearing conditions, both through empirical experiments and computational validation, will provide valuable insights for future micro ECMO device development by directly relating geometric and shear stress with hemolysis levels. We propose that, with an informed selection of hemolysis parameters based on the shear ranges of the test device, computational modeling can complement empirical testing in the development of novel high-flow blood-contacting microfluidic devices, allowing for a more efficient iterative design process. Furthermore, the low device-induced hemolysis measured in our study at physiologically relevant flow rates is promising for the future development of microfluidic oxygenators and dialyzers.
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Affiliation(s)
- Nayeem Imtiaz
- Rochester Institute of Technology, Kate Gleason College of Engineering, Rochester, NY 14623, USA; (N.I.); (W.A.S.); (T.R.G.)
| | - Matthew D. Poskus
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - William A. Stoddard
- Rochester Institute of Technology, Kate Gleason College of Engineering, Rochester, NY 14623, USA; (N.I.); (W.A.S.); (T.R.G.)
| | - Thomas R. Gaborski
- Rochester Institute of Technology, Kate Gleason College of Engineering, Rochester, NY 14623, USA; (N.I.); (W.A.S.); (T.R.G.)
| | - Steven W. Day
- Rochester Institute of Technology, Kate Gleason College of Engineering, Rochester, NY 14623, USA; (N.I.); (W.A.S.); (T.R.G.)
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Isenberg BC, Vedula EM, Santos J, Lewis DJ, Roberts TR, Harea G, Sutherland D, Landis B, Blumenstiel S, Urban J, Lang D, Teece B, Lai W, Keating R, Chiang D, Batchinsky AI, Borenstein JT. A Clinical-Scale Microfluidic Respiratory Assist Device with 3D Branching Vascular Networks. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2207455. [PMID: 37092588 PMCID: PMC10288269 DOI: 10.1002/advs.202207455] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/10/2023] [Indexed: 05/03/2023]
Abstract
Recent global events such as COVID-19 pandemic amid rising rates of chronic lung diseases highlight the need for safer, simpler, and more available treatments for respiratory failure, with increasing interest in extracorporeal membrane oxygenation (ECMO). A key factor limiting use of this technology is the complexity of the blood circuit, resulting in clotting and bleeding and necessitating treatment in specialized care centers. Microfluidic oxygenators represent a promising potential solution, but have not reached the scale or performance required for comparison with conventional hollow fiber membrane oxygenators (HFMOs). Here the development and demonstration of the first microfluidic respiratory assist device at a clinical scale is reported, demonstrating efficient oxygen transfer at blood flow rates of 750 mL min⁻1 , the highest ever reported for a microfluidic device. The central innovation of this technology is a fully 3D branching network of blood channels mimicking key features of the physiological microcirculation by avoiding anomalous blood flows that lead to thrombus formation and blood damage in conventional oxygenators. Low, stable blood pressure drop, low hemolysis, and consistent oxygen transfer, in 24-hour pilot large animal experiments are demonstrated - a key step toward translation of this technology to the clinic for treatment of a range of lung diseases.
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Affiliation(s)
| | | | - Jose Santos
- Bioengineering DivisionDraperCambridgeMA02139USA
| | | | - Teryn R. Roberts
- Autonomous Reanimation and Evacuation (AREVA) Research ProgramThe Geneva FoundationSan AntonioTX78234USA
| | - George Harea
- Autonomous Reanimation and Evacuation (AREVA) Research ProgramThe Geneva FoundationSan AntonioTX78234USA
| | | | - Beau Landis
- Bioengineering DivisionDraperCambridgeMA02139USA
| | | | - Joseph Urban
- Bioengineering DivisionDraperCambridgeMA02139USA
| | - Daniel Lang
- Bioengineering DivisionDraperCambridgeMA02139USA
| | - Bryan Teece
- Bioengineering DivisionDraperCambridgeMA02139USA
| | - WeiXuan Lai
- Bioengineering DivisionDraperCambridgeMA02139USA
| | - Rose Keating
- Bioengineering DivisionDraperCambridgeMA02139USA
| | - Diana Chiang
- Bioengineering DivisionDraperCambridgeMA02139USA
| | - Andriy I. Batchinsky
- Autonomous Reanimation and Evacuation (AREVA) Research ProgramThe Geneva FoundationSan AntonioTX78234USA
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Abstract
Extracorporeal membrane oxygenation (ECMO) has been advancing rapidly due to a combination of rising rates of acute and chronic lung diseases as well as significant improvements in the safety and efficacy of this therapeutic modality. However, the complexity of the ECMO blood circuit, and challenges with regard to clotting and bleeding, remain as barriers to further expansion of the technology. Recent advances in microfluidic fabrication techniques, devices, and systems present an opportunity to develop new solutions stemming from the ability to precisely maintain critical dimensions such as gas transfer membrane thickness and blood channel geometries, and to control levels of fluid shear within narrow ranges throughout the cartridge. Here, we present a physiologically inspired multilayer microfluidic oxygenator device that mimics physiologic blood flow patterns not only within individual layers but throughout a stacked device. Multiple layers of this microchannel device are integrated with a three-dimensional physiologically inspired distribution manifold that ensures smooth flow throughout the entire stacked device, including the critical entry and exit regions. We then demonstrate blood flows up to 200 ml/min in a multilayer device, with oxygen transfer rates capable of saturating venous blood, the highest of any microfluidic oxygenator, and a maximum blood flow rate of 480 ml/min in an eight-layer device, higher than any yet reported in a microfluidic device. Hemocompatibility and large animal studies utilizing these prototype devices are planned. Supplemental Visual Abstract, http://links.lww.com/ASAIO/A769.
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Minato T, Yamaguchi T, Hoshizaki M, Nirasawa S, An J, Takahashi S, Penninger JM, Imai Y, Kuba K. ACE2-like enzyme B38-CAP suppresses abdominal sepsis and severe acute lung injury. PLoS One 2022; 17:e0270920. [PMID: 35867642 PMCID: PMC9307200 DOI: 10.1371/journal.pone.0270920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/17/2022] [Indexed: 11/19/2022] Open
Abstract
Angiotensin-converting enzyme 2 (ACE2) is the carboxypeptidase to degrade angiotensin II (Ang II) to angiotensin 1–7 (Ang 1–7) and improves the pathologies of cardiovascular disease and acute respiratory distress syndrome (ARDS)/acute lung injury. B38-CAP is a bacteria-derived ACE2-like carboxypeptidase as potent as human ACE2 and ameliorates hypertension, heart failure and SARS-CoV-2-induced lung injury in mice. Recombinant B38-CAP is prepared with E. coli protein expression system more efficiently than recombinant soluble human ACE2. Here we show therapeutic effects of B38-CAP on abdominal sepsis- or acid aspiration-induced acute lung injury. ACE2 expression was downregulated in the lungs of mice with cecal ligation puncture (CLP)-induced sepsis or acid-induced lung injury thereby leading to upregulation of Ang II levels. Intraperitoneal injection of B38-CAP significantly decreased Ang II levels while upregulated angiotensin 1–7 levels. B38-CAP improved survival rate of the mice under sepsis. B38-CAP suppressed the pathologies of lung inflammation, improved lung dysfunction and downregulated elevated cytokine mRNA levels in the mice with acute lung injury. Thus, systemic treatment with an ACE2-like enzyme might be a potential therapeutic strategy for the patients with severe sepsis or ARDS.
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Affiliation(s)
- Takafumi Minato
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, Akita, Japan
| | - Tomokazu Yamaguchi
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, Akita, Japan
| | - Midori Hoshizaki
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, Akita, Japan
- Laboratory of Regulation of Intractable Infectious Diseases, National Institute of Biomedical Innovation, Health and Nutrition (NIBIOHN), Ibaraki, Osaka, Japan
| | - Satoru Nirasawa
- Biological Resources and Post-Harvest Division, Japan International Research Center for Agricultural Sciences, Tsukuba, Ibaraki, Japan
| | - Jianbo An
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, Akita, Japan
| | | | - Josef M. Penninger
- Department of Medical Genetics, Life Science Institute, University of British Columbia, Vancouver, BC, Canada
| | - Yumiko Imai
- Laboratory of Regulation of Intractable Infectious Diseases, National Institute of Biomedical Innovation, Health and Nutrition (NIBIOHN), Ibaraki, Osaka, Japan
| | - Keiji Kuba
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, Akita, Japan
- * E-mail:
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Santos J, Vedula EM, Lai W, Isenberg BC, Lewis DJ, Lang D, Sutherland D, Roberts TR, Harea GT, Wells C, Teece B, Karandikar P, Urban J, Risoleo T, Gimbel A, Solt D, Leazer S, Chung KK, Sukavaneshvar S, Batchinsky AI, Borenstein JT. Toward Development of a Higher Flow Rate Hemocompatible Biomimetic Microfluidic Blood Oxygenator. MICROMACHINES 2021; 12:888. [PMID: 34442512 PMCID: PMC8398684 DOI: 10.3390/mi12080888] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/18/2021] [Accepted: 07/24/2021] [Indexed: 01/05/2023]
Abstract
The recent emergence of microfluidic extracorporeal lung support technologies presents an opportunity to achieve high gas transfer efficiency and improved hemocompatibility relative to the current standard of care in extracorporeal membrane oxygenation (ECMO). However, a critical challenge in the field is the ability to scale these devices to clinically relevant blood flow rates, in part because the typically very low blood flow in a single layer of a microfluidic oxygenator device requires stacking of a logistically challenging number of layers. We have developed biomimetic microfluidic oxygenators for the past decade and report here on the development of a high-flow (30 mL/min) single-layer prototype, scalable to larger structures via stacking and assembly with blood distribution manifolds. Microfluidic oxygenators were designed with biomimetic in-layer blood distribution manifolds and arrays of parallel transfer channels, and were fabricated using high precision machined durable metal master molds and microreplication with silicone films, resulting in large area gas transfer devices. Oxygen transfer was evaluated by flowing 100% O2 at 100 mL/min and blood at 0-30 mL/min while monitoring increases in O2 partial pressures in the blood. This design resulted in an oxygen saturation increase from 65% to 95% at 20 mL/min and operation up to 30 mL/min in multiple devices, the highest value yet recorded in a single layer microfluidic device. In addition to evaluation of the device for blood oxygenation, a 6-h in vitro hemocompatibility test was conducted on devices (n = 5) at a 25 mL/min blood flow rate with heparinized swine donor blood against control circuits (n = 3). Initial hemocompatibility results indicate that this technology has the potential to benefit future applications in extracorporeal lung support technologies for acute lung injury.
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Affiliation(s)
- Jose Santos
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Else M. Vedula
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Weixuan Lai
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Brett C. Isenberg
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Diana J. Lewis
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Dan Lang
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - David Sutherland
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Teryn R. Roberts
- Autonomous Reanimation and Evacuation (AREVA) Research Program, The Geneva Foundation, Brooks City Base, San Antonio, TX 78006, USA; (T.R.R.); (G.T.H.); (A.I.B.)
| | - George T. Harea
- Autonomous Reanimation and Evacuation (AREVA) Research Program, The Geneva Foundation, Brooks City Base, San Antonio, TX 78006, USA; (T.R.R.); (G.T.H.); (A.I.B.)
| | - Christian Wells
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Bryan Teece
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Paramesh Karandikar
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Joseph Urban
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Thomas Risoleo
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Alla Gimbel
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Derek Solt
- Thrombodyne, Inc., Salt Lake City, UT 84103, USA; (D.S.); (S.S.)
| | - Sahar Leazer
- Department of Medicine, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (S.L.); (K.K.C.)
| | - Kevin K. Chung
- Department of Medicine, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (S.L.); (K.K.C.)
| | | | - Andriy I. Batchinsky
- Autonomous Reanimation and Evacuation (AREVA) Research Program, The Geneva Foundation, Brooks City Base, San Antonio, TX 78006, USA; (T.R.R.); (G.T.H.); (A.I.B.)
| | - Jeffrey T. Borenstein
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
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Gimbel AA, Hsiao JC, Kim ES, Lewis DJ, Risoleo TF, Urban JN, Borenstein JT. A high gas transfer efficiency microfluidic oxygenator for extracorporeal respiratory assist applications in critical care medicine. Artif Organs 2021; 45:E247-E264. [PMID: 33561881 DOI: 10.1111/aor.13935] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/10/2021] [Accepted: 02/05/2021] [Indexed: 12/15/2022]
Abstract
Advances in microfluidics technologies have spurred the development of a new generation of microfluidic respiratory assist devices, constructed using microfabrication techniques capable of producing microchannel dimensions similar to those found in human capillaries and gas transfer films in the same thickness range as the alveolar membrane. These devices have been tested in laboratory settings and in some cases in extracorporeal animal experiments, yet none have been advanced to human clinical studies. A major challenge in the development of microfluidic oxygenators is the difficulty in scaling the technology toward high blood flows necessary to support adult humans; such scaling efforts are often limited by the complexity of the fabrication process and the manner in which blood is distributed in a three-dimensional network of microchannels. Conceptually, a central advantage of microfluidic oxygenators over existing hollow-fiber membrane-based configurations is the potential for shallower channels and thinner gas transfer membranes, features that reduce oxygen diffusion distances, to result in a higher gas transfer efficiency defined as the ratio of the volume of oxygen transferred to the blood per unit time to the active surface area of the gas transfer membrane. If this ratio is not significantly higher than values reported for hollow fiber membrane oxygenators (HFMO), then the expected advantage of the microfluidic approach would not be realized in practice, potentially due to challenges encountered in blood distribution strategies when scaling microfluidic designs to higher flow rates. Here, we report on scaling of a microfluidic oxygenator design from 4 to 92 mL/min blood flow, within an order of magnitude of the flow rate required for neonatal applications. This scaled device is shown to have a gas transfer efficiency higher than any other reported system in the literature, including other microfluidic prototypes and commercial HFMO cartridges. While the high oxygen transfer efficiency is a promising advance toward clinical scaling of a microfluidic architecture, it is accompanied by an excessive blood pressure drop in the circuit, arising from a combination of shallow gas transfer channels and equally shallow distribution manifolds. Therefore, next-generation microfluidic oxygenators will require novel design and fabrication strategies to minimize pressure drops while maintaining very high oxygen transfer efficiencies.
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Affiliation(s)
| | | | - Ernest S Kim
- Bioengineering Division, Draper, Cambridge, MA, USA
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Extracorporeal Membrane Oxygenation Can Successfully Support Patients With Severe Acute Respiratory Distress Syndrome in Lieu of Mechanical Ventilation. Crit Care Med 2019; 46:e1070-e1073. [PMID: 30095500 PMCID: PMC6185806 DOI: 10.1097/ccm.0000000000003354] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Extracorporeal membrane oxygenation is increasingly used in the management of severe acute respiratory distress syndrome. With extracorporeal membrane oxygenation, select patients with acute respiratory distress syndrome can be managed without mechanical ventilation, sedation, or neuromuscular blockade. Published experience with this approach, specifically with attention to a patient's respiratory drive following cannulation, is limited. DESIGN We describe our experience with three consecutive patients with severe acute respiratory distress syndrome supported with right jugular-femoral configuration of venovenous extracorporeal membrane oxygenation without therapeutic anticoagulation as an alternative to lung-protective mechanical ventilation. Outcomes are reported including daily respiratory rate, vital capacities, and follow-up pulmonary function testing. RESULTS Following cannulation, patients were extubated within 24 hours. During extracorporeal membrane oxygenation support, all patients were able to maintain a normal respiratory rate and experienced steady improvements in vital capacities. Patients received oral nutrition and ambulated daily. At follow-up, no patients required supplemental oxygen. CONCLUSIONS Our results suggest that venovenous extracorporeal membrane oxygenation can provide a safe and effective alternative to lung-protective mechanical ventilation in carefully selected patients. This approach facilitates participation in physical therapy and avoids complications associated with mechanical ventilation.
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Al-Fares A, Pettenuzzo T, Del Sorbo L. Extracorporeal life support and systemic inflammation. Intensive Care Med Exp 2019; 7:46. [PMID: 31346840 PMCID: PMC6658641 DOI: 10.1186/s40635-019-0249-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/22/2019] [Indexed: 01/10/2023] Open
Abstract
Extracorporeal life support (ECLS) encompasses a wide range of extracorporeal modalities that offer short- and intermediate-term mechanical support to the failing heart or lung. Apart from the daily use of cardiopulmonary bypass (CPB) in the operating room, there has been a resurgence of interest and utilization of veno-arterial and veno-venous extracorporeal membrane oxygenation (VA- and VV-ECMO, respectively) and extracorporeal carbon dioxide removal (ECCO2R) in recent years. This might be attributed to the advancement in technology, nonetheless the morbidity and mortality associated with the clinical application of this technology is still significant. The initiation of ECLS triggers a systemic inflammatory response, which involves the activation of the coagulation cascade, complement systems, endothelial cells, leukocytes, and platelets, thus potentially contributing to morbidity and mortality. This is due to the release of cytokines and other biomarkers of inflammation, which have been associated with multiorgan dysfunction. On the other hand, ECLS can be utilized as a therapy to halt the inflammatory response associated with critical illness and ICU therapeutic intervention, such as facilitating ultra-protective mechanical ventilation. In addition to addressing the impact on outcome of the relationship between inflammation and ECLS, two different but complementary pathophysiological perspectives will be developed in this review: ECLS as the cause of inflammation and ECLS as the treatment of inflammation. This framework may be useful in guiding the development of novel therapeutic strategies to improve the outcome of critical illness.
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Affiliation(s)
- Abdulrahman Al-Fares
- Adult Critical Care Medicine Fellowship Program, University of Toronto, Toronto, Canada.,Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait.,Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Tommaso Pettenuzzo
- Adult Critical Care Medicine Fellowship Program, University of Toronto, Toronto, Canada.,Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Lorenzo Del Sorbo
- Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada. .,Toronto General Hospital, 585 University Avenue, PMB 11-122, Toronto, Ontario, M5G 2 N2, Canada.
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Fan E. "There Is Nothing New Except What Has Been Forgotten": The Story of Mechanical Ventilation during Extracorporeal Support. Am J Respir Crit Care Med 2019; 199:550-553. [PMID: 30281337 DOI: 10.1164/rccm.201809-1728ed] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Eddy Fan
- 1 Interdepartmental Division of Critical Care Medicine.,2 Institute of Health Policy, Management and Evaluation University of Toronto Toronto, Canada and.,3 University Health Network Toronto, Canada
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10
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Metkus TS, Guallar E, Sokoll L, Morrow DA, Tomaselli G, Brower R, Kim BS, Schulman S, Korley FK. Progressive myocardial injury is associated with mortality in the acute respiratory distress syndrome. J Crit Care 2018; 48:26-31. [PMID: 30138905 PMCID: PMC6226321 DOI: 10.1016/j.jcrc.2018.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/07/2018] [Accepted: 08/13/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE Myocardial injury connotes worse prognosis in the Acute Respiratory Distress Syndrome (ARDS), however the prognostic connotation of changes in cardiac troponin (cTn) levels in ARDS patients is not known. METHODS We performed a study of 908 ARDS patients enrolled in two previously completed ARDS Network trials. We obtained plasma samples via the NIH BIOLINCC repository and measured cTn using the ARCHITECT STAT high sensitivity troponin-I assay (Abbott Laboratories) at trial day 0 and 3. We constructed Cox proportional hazard models to determine the association between 60-day mortality and quintiles of percentage change in high-sensitivity troponin (ΔhsTnI). RESULTS The median percent change in hsTnI (%ΔhsTnI) from day 0 to day 3 was -58.2% (IQR -79.0 to 0%). After multivariable adjustment, participants with a 32.1% or greater increase in hsTnI between day 0 and day 3 (highest quintile) had a 2.27 fold increased risk for mortality (95% CI 1.29 - 3.99, p = 0.002) as well as fewer ventilator-free and ICU-free days compared to the lowest quintile. CONCLUSION Progressive myocardial injury in ARDS patients is associated with worse outcome, independent of severity of critical illness. Investigation of the mechanisms underlying this relationship is warranted to guide possible strategies to mitigate myocardial injury in ARDS.
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Affiliation(s)
- Thomas S Metkus
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, United States.
| | - Eliseo Guallar
- Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, United States
| | - Lori Sokoll
- Department of Pathology, Johns Hopkins University School of Medicine, United States
| | - David A Morrow
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, United States
| | - Gordon Tomaselli
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, United States
| | - Roy Brower
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, United States
| | - Bo Soo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, United States
| | - Steven Schulman
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, United States
| | - Frederick K Korley
- Department of Emergency Medicine, University of Michigan Medical School, United States
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