ECMO without Anticoagulation

项目摘要/摘要 通过膜氧合器(ECMO)进行体外循环的生命支持是一种 高级重症监护的中流砥柱。然而，ECMO循环中的凝块和从ECMO循环中出血 患者是主要的并发症，占患者发病率和死亡率的30%。 表面涂层是可用的，但仍然需要系统的抗凝血，因为这些 表面并不能阻止血小板黏附和激活。我们已经开发出一种不会导致血栓形成的 防止血小板在表面激活的表面。这样就不再需要 全身抗凝，防止大出血和电路凝块并发症。这个 表面是基于一氧化氮(NO)的，这是表面抗凝的机制 正常的内皮细胞。对化学成分、涂层、不生成和效果进行了测试 在初步研究中。这项研究将完善一氧化氮表面抗凝系统 (NOSA)，并证明了与全身抗凝相比的有效性。结果将会是 适用于血液透析等其他体外装置的非血栓形成表面， 血液滤过和体外循环。

PROJECT SUMMARY/ABSTRACT Life support with extracorporeal circulation through a membrane oxygenator (ECMO) is a mainstay of advanced critical care. However, clotting in the ECMO circuit and bleeding from the patient are the major complications, accounting for morbidity and mortality in 30% of patients. Surface–based coatings are available, but still require systemic anticoagulation because these surfaces do not prevent platelet adhesion and activation. We have developed a nonthrombogenic surface which prevents platelet activation at the surface. This could eliminate the need for systemic anticoagulation and prevent major bleeding and circuit clotting complications. The surface is based on nitric oxide (NO), which is the mechanism of surface anticoagulation of the normal endothelium. The chemistry, coating, NO generation, and effectiveness have been tested in preliminary studies. This research will refine the nitric oxide surface anticoagulation system (NOSA), and demonstrate effectiveness compared to systemic anticoagulation. The results will apply to nonthrombogenic surfaces for other extracorporeal devices such as hemodialysis, hemofiltration, and cardiopulmonary bypass.