无全身抗凝的无泵人工肺：一氧化氮表面抗凝系统。
A pumpless artificial lung without systemic anticoagulation: The Nitric Oxide Surface Anticoagulation system.
机构信息
Extracorporeal Life Support Laboratory, Department of Surgery, Michigan Medicine, B560 MSRB II/SPC 5686, 1150 W. Medical Center Drive, Ann Arbor, MI 48109, USA.
Extracorporeal Life Support Laboratory, Department of Surgery, Michigan Medicine, B560 MSRB II/SPC 5686, 1150 W. Medical Center Drive, Ann Arbor, MI 48109, USA.
出版信息
J Pediatr Surg. 2022 Jan;57(1):26-33. doi: 10.1016/j.jpedsurg.2021.09.015. Epub 2021 Sep 20.
BACKGROUND
Artificial lungs have the potential to serve as a bridge to transplantation or recovery for children with end-stage lung disease dependent on extracorporeal life support, but such devices currently require systemic anticoagulation. We describe our experience using the novel Nitric Oxide (NO) Surface Anticoagulation (NOSA) system-an NO-releasing circuit with NO in the sweep gas-with the Pediatric MLung-a low-resistance, pumpless artificial lung.
METHODS
NO flux testing: MLungs (n = 4) were tested using veno-venous extracorporeal life support in a sheep under anesthesia with blood flow set to 0.5 and 1 L/min and sweep gas blended with 100 ppm NO at 1, 2, and 4 L/min. NO and NO were measured in the sweep and exhaust gas to calculate NO flux across the MLung membrane. Pumpless implants: Sheep (20-100 kg, n = 3) underwent thoracotomy and cannulation via the pulmonary artery (device inflow) and left atrium (device outflow) using cannulae and circuit components coated with an NO donor (diazeniumdiolated dibutylhexanediamine; DBHD-NO) and argatroban. Animals were connected to the MLung with 100 ppm NO in the sweep gas under anesthesia for 24 h with no systemic anticoagulation after cannulation.
RESULTS
NO flux testing: NO flux averaged 3.4 ± 1.0 flux units (x10 mol/cm/min) (human vascular endothelium: 0.5-4 flux units). Pumpless implants: 3 sheep survived 24 h with patent circuits. MLung blood flow was 716 ± 227 mL/min. Outlet oxygen saturation was 98.3 ± 2.6%. Activated clotting time was 151±24 s. Platelet count declined from 334,333 ± 112,225 to 123,667 ± 7,637 over 24 h. Plasma free hemoglobin and leukocyte and platelet activation did not significantly change.
CONCLUSIONS
The NOSA system provides NO flux across a gas-exchange membrane of a pumpless artificial lung at a similar rate as native vascular endothelium and achieves effective local anticoagulation of an artificial lung circuit for 24 h.
背景
人工肺有可能成为依赖体外生命支持的终末期肺病儿童进行移植或恢复的桥梁，但此类设备目前需要全身抗凝。我们描述了使用新型一氧化氮（NO）表面抗凝（NOSA）系统-一种带有吹扫气中 NO 的 NO 释放回路-与儿科 MLung（一种低阻力、无泵人工肺）一起使用的经验。
方法
NO 通量测试：使用静脉-静脉体外生命支持，在麻醉状态下将绵羊的血流量设置为 0.5 和 1 L/min，将吹扫气与 100 ppm 的 NO 混合，流速为 1、2 和 4 L/min，对 4 个 MLung 进行测试。测量吹扫气和废气中的 NO 和 NO，以计算 MLung 膜的 NO 通量。无泵植入物：通过肺动脉（设备流入）和左心房（设备流出）将绵羊（20-100 公斤，n=3）进行开胸手术和插管，使用涂有一氧化氮供体（二氮烯二丁基己二胺；DBHD-NO）和阿加曲班的插管和回路组件。动物在麻醉下用吹扫气中的 100 ppm 的 NO 连接到 MLung，在插管后无需全身抗凝即可使用 24 小时。
结果
NO 通量测试：NO 通量平均为 3.4±1.0 通量单位（x10 mol/cm/min）（人血管内皮：0.5-4 通量单位）。无泵植入物：3 只绵羊存活 24 小时，回路通畅。MLung 血流为 716±227 mL/min。出口氧饱和度为 98.3±2.6%。激活的凝血时间为 151±24 s。血小板计数从 24 小时内从 334,333±112,225 降至 123,667±7,637。血浆游离血红蛋白以及白细胞和血小板激活没有明显变化。
结论
NOSA 系统在无泵人工肺的气体交换膜上提供与天然血管内皮相似的 NO 通量，并在 24 小时内实现人工肺回路的有效局部抗凝。
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