Lehle Karla, Philipp Alois, Gleich Otto, Holzamer Andreas, Müller Thomas, Bein Thomas, Schmid Christof
Department of Cardiothoracic Surgery, University of Regensburg, Regensburg, Germany.
ASAIO J. 2008 Nov-Dec;54(6):612-7. doi: 10.1097/MAT.0b013e318186a807.
Bioline-coated polymethylpentene (PMP) membrane oxygenators (MO) are used for extracorporeal membrane oxygenation (ECMO) to improve gas exchange in patients with severe acute respiratory distress syndrome (ARDS). However, in some patients, long-term durability is limited due to fibrous and cellular accumulations on the gas exchange surface which can increase resistance to blood flow and diffusion path. These surface deposits of PMP MO after removal were studied with scanning electron and fluorescence microscopy techniques. Three of 31 patients supported by a PMP MO in an ECMO setting required a replacement of the oxygenator after a mean support interval of 11 +/- 7 days due to an increase in flow resistance and an impairment of the gas exchange capacity. The membrane surface of the MO was covered with a fibrous network with imbedded platelets and red blood cells. A membranous structure composed of single cells and clusters of cells covered large areas of the PMP fibers. We assume that these cellular deposits lower the efficacy of ECMO. The identification of these cells could be a key for future therapeutic interventions and improvements in the development of MO.
生物素涂层的聚甲基戊烯（PMP）膜式氧合器（MO）用于体外膜肺氧合（ECMO），以改善重症急性呼吸窘迫综合征（ARDS）患者的气体交换。然而，在一些患者中，由于气体交换表面的纤维和细胞堆积，长期耐用性受到限制，这会增加血流阻力和扩散路径。采用扫描电子显微镜和荧光显微镜技术对移除后的PMP MO的这些表面沉积物进行了研究。在ECMO环境中，31例接受PMP MO支持的患者中有3例在平均支持时间11±7天后因血流阻力增加和气体交换能力受损而需要更换氧合器。MO的膜表面覆盖着一个嵌入血小板和红细胞的纤维网络。由单细胞和细胞簇组成的膜状结构覆盖了PMP纤维的大片区域。我们认为这些细胞沉积物会降低ECMO的疗效。识别这些细胞可能是未来治疗干预和MO开发改进的关键。
