ECMO without Anticoagulation

项目总结/摘要 通过膜式氧合器（ECMO）进行体外循环的生命支持是一种 先进的重症监护的支柱。然而，体外膜肺氧合循环中的凝血和 是患者的主要并发症，占患者发病率和死亡率的30%。 表面涂层是可用的，但仍然需要全身抗凝，因为这些 表面不能阻止血小板粘附和活化。我们研制出了一种无血栓的 表面，防止血小板在表面活化。这可以消除对 全身抗凝和预防大出血和回路凝血并发症。的 表面是基于一氧化氮（NO），这是表面抗凝的机制， 正常内皮细胞。对化学、涂层、NO生成和有效性进行了测试 初步研究。本研究将完善一氧化氮表面抗凝系统 （NOSA），并证明与全身抗凝相比的有效性。结果将 适用于其他体外装置（如血液透析）的非血栓形成表面， 血液滤过和心肺分流术。

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.