Hyperbaric phototherapy augments blood carbon monoxide removal
Hyperbaric phototherapy augments blood carbon monoxide removal
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DOI：
10.1002/lsm.23486
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发表时间：
2021-10-17
影响因子：
2.4
通讯作者：
Zapol, Warren M.
中科院分区：
文献类型：
--
作者：
Fischbach, Anna;Traeger, Lisa;Zapol, Warren M.
背景和目的一氧化碳（CO）中毒是负责近50,000急诊就诊和1200人死亡，每年。与氧相比，CO对血红蛋白（Hb）的亲和力高250倍，导致氧从Hb中置换，并损害氧向组织的输送。CO中毒患者的最佳治疗包括给予高压100%氧气，以清除Hb中的CO并恢复氧气输送。然而，高压氧舱并不广泛使用，这种治疗需要将一氧化碳中毒的患者运送到专门的中心，这可能导致治疗延迟。已知可见光使CO从碳氧血红蛋白（COHb）中解离。在以前的研究中，我们表明，由六个光体外膜氧合（ECMO）设备组成的系统有效地去除了CO中毒的大型动物的CO。在这项研究中，我们测试了一个假设，即高压氧的光ECMO设备的应用将进一步增加CO的消除率。研究设计/材料和方法我们开发了一种高压光ECMO设备，并评估了该设备从CO中毒的人血液中去除CO的能力。我们将四种设备组合成一个“高压光ECMO系统”，并将其清除CO的能力与我们先前描述的光ECMO系统进行了比较，该系统由六个设备组成，用常压氧通气。结果在常压条件下，氧气浓度从21%增加到100%显著增加了CO中毒血液在单次通过装置后的CO清除。光ECMO装置内的氧压增加与较高的排出血液PO 2水平和增加的CO消除相关。四个高压光ECMO设备的系统从1 L CO中毒的血液中去除CO的速度与由六个设备组成的原始常压光ECMO系统一样快。结论本研究证实了高压光-ECMO系统对提高CO中毒患者清除率的可行性和有效性。这项技术可以提供一个简单的便携式急救设备，并促进立即治疗CO中毒患者在或附近的受伤部位。
Background and Objectives Carbon monoxide (CO) poisoning is responsible for nearly 50,000 emergency department visits and 1200 deaths per year. Compared to oxygen, CO has a 250-fold higher affinity for hemoglobin (Hb), resulting in the displacement of oxygen from Hb and impaired oxygen delivery to tissues. Optimal treatment of CO-poisoned patients involves the administration of hyperbaric 100% oxygen to remove CO from Hb and to restore oxygen delivery. However, hyperbaric chambers are not widely available and this treatment requires transporting a CO-poisoned patient to a specialized center, which can result in delayed treatment. Visible light is known to dissociate CO from carboxyhemoglobin (COHb). In a previous study, we showed that a system composed of six photo-extracorporeal membrane oxygenation (ECMO) devices efficiently removes CO from a large animal with CO poisoning. In this study, we tested the hypothesis that the application of hyperbaric oxygen to the photo-ECMO device would further increase the rate of CO elimination. Study Design/Material and Methods We developed a hyperbaric photo-ECMO device and assessed the ability of the device to remove CO from CO-poisoned human blood. We combined four devices into a "hyperbaric photo-ECMO system" and compared its ability to remove CO to our previously described photo-ECMO system, which was composed of six devices ventilated with normobaric oxygen. Results Under normobaric conditions, an increase in oxygen concentration from 21% to 100% significantly increased CO elimination from CO-poisoned blood after a single pass through the device. Increased oxygen pressure within the photo-ECMO device was associated with higher exiting blood PO2 levels and increased CO elimination. The system of four hyperbaric photo-ECMO devices removed CO from 1 L of CO-poisoned blood as quickly as the original, normobaric photo-ECMO system composed of six devices. Conclusion This study demonstrates the feasibility and efficacy of using a hyperbaric photo-ECMO system to increase the rate of CO elimination from CO-poisoned blood. This technology could provide a simple portable emergency device and facilitate immediate treatment of CO-poisoned patients at or near the site of injury.