Angel Pan
Research Mentor: Alvaro Rojas-Peña
Mentor Department: Department of Surgery-Transplantation, Medicine
Author(s): Angel Pan, Ninette Musili, Ryan Kauffman, Lauren Griffin, Ronald Shebuski, Alvaro Rojas-Pena
Session: Session 5 (2:00 PM – 2:50 PM)
Presentation Type: Poster 28
Abstract
Introduction: The utilization of extracorporeal membrane oxygenation (ECMO) as critical support for patients with severe cardiorespiratory failure is associated with hemorrhagic complications secondary to systemic anticoagulation needed to prevent thrombosis of the circuit. Nitric oxide (NO) is an endogenous gas released by endothelial cells that inhibits platelet adhesion, regulates vasodilation. We aimed to evaluate the effect of using S-Nitroso-N-acetylpenicillamine tethered liquid perfluorocarbon (SNAP-TLP)-coated, NO-releasing ECMO circuits compared to standard, heparinized ECMO circuits in ovine models on circuit thrombosis, and associated complication rates. Methods: Ten sheep were anesthetized and placed on venovenous (VV) ECMO via internal jugular and femoral vein cannulation. 5 animals were placed on standard ECMO circuit with heparin anticoagulation as control and 5 animals were placed on NO-infused ECMO circuits without systemic anticoagulation. Animals were monitored over a duration of five days, or until end criteria were met in the ovine ICU. Hemodynamic evaluation included mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Bleeding complications were qualitatively recorded. Activated clotting time (ACT) was also tested and evaluated. Results: Average MAP was 94.71±15.85 (95%CI [93.77-95.65]) and 98.32±19.85 (95%CI [96.89-99.74]) mmHg for the control and experimental groups, respectively (p=0.00003617). Average SBP and DBP for the controls was 112.42±15.06 (95% CI [111.52-113.31]), 75.61±17.59 (95% CI [74.56-76.65]) mmHg, and 108.93±21.77 (95% CI [107.36-110.49]), 87.78±19.07 (95% CI [86.41-89.15]) mmHg for the experimental group (p=0.0001476 SBP, p<0.00001 DBP). On average, the experimental group had HR of 113.46±17.5 (95% CI [112.21-114.72]) beats per minute (bpm) compared to the control group’s 107.83±21.51 (95% CI [106.55-109.11]) bpm (p=0.1844). All five animals on systemic anticoagulation had bleeding complications (2 from femoral site, 1 from jugular, 2 from both). Two had visible hematomas. One of the animals on the NO-infused circuit had bleeding from the jugular incision site. Average ACT of the experimental group was 184.94±49.06 (95% CI [174.61-195.28]) seconds and 234.94±48.68 (95% CI [228.63-241.25]) seconds for the control group (p<0.00001). Conclusion: NO-releasing ECMO circuits are associated with fewer bleeding complications compared to standard ECMO circuits requiring anticoagulation. However between the two circuits, there was no clinically significant hemodynamic variation as seen on MAP and HR.
