Antonsen Lars Prag, Landsverk Svein Aslak, Halvorsen Per Steinar, Thiara Amrit, Lilja Didrik, Nesaragi Naimahmed, Espinoza Andreas
Department of Anesthesia and Intensive Care, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway.
Department of Anesthesia and Intensive Care, Østfold Hospital Trust, Kalnesveien 300, 1714, Grålum, Norway.
Intensive Care Med Exp. 2025 Jun 2;13(1):55. doi: 10.1186/s40635-025-00763-7.
Oxygenator thrombosis is a potentially life-threatening complication during venovenous extracorporeal membrane oxygenation (VV ECMO). It can cause blood flow obstruction, impaired gas exchange, hematologic abnormalities, or sudden ECMO flow cessation. Early detection and timely circuit exchange is critical yet challenging. Acute clot formation necessitates immediate circuit replacement, while premature replacement risks unnecessary procedural harm and increased costs. No reliable method exists to detect early oxygenator thrombosis. Strategies include visual inspection, monitoring the pressure difference across the oxygenator (ΔP), gas exchange evaluation, and blood tests. In the present animal study, we aimed to evaluate the feasibility of accelerometer-based vibration analysis as a real-time and non-invasive method for detecting oxygenator thrombosis during VV ECMO. We hypothesized that accelerometer signals would change concurrently with or precede increases in ΔP.
The study was performed on anesthetized and mechanically ventilated pigs (n = 7) on VV ECMO. Hemodynamic parameters, ECMO circuit pressures, and signals from an accelerometer attached to the ECMO oxygenator were continuously recorded at different pump speeds, and after anticoagulation reversal to promote thrombosis within the ECMO oxygenator.
The primary finding of this study was a significant increase in the accelerometer signal's Root Mean Squared (RMS) 15 min after anticoagulation reversal, with no rpm adjustment and without corresponding changes in ΔP. Variations in RMS associated with high ECMO pump speed and circuit flow were discernible from those observed following anticoagulation reversal.
The present animal study demonstrates the feasibility of accelerometer-based vibration analysis as a real-time and non-invasive method for detecting vibrations associated with reversal of anticoagulation and potential oxygenator thrombosis during VV ECMO.
在静脉-静脉体外膜肺氧合（VV ECMO）期间，氧合器血栓形成是一种潜在的危及生命的并发症。它可导致血流阻塞、气体交换受损、血液学异常或ECMO血流突然停止。早期检测和及时更换回路至关重要但具有挑战性。急性血栓形成需要立即更换回路，而过早更换则有不必要的操作伤害和成本增加的风险。目前尚无可靠的方法来检测早期氧合器血栓形成。策略包括目视检查、监测氧合器两端的压力差（ΔP）、气体交换评估和血液检查。在本项动物研究中，我们旨在评估基于加速度计的振动分析作为一种实时、非侵入性方法检测VV ECMO期间氧合器血栓形成的可行性。我们假设加速度计信号会在ΔP增加的同时或之前发生变化。
本研究在接受麻醉并机械通气的猪（n = 7）上进行VV ECMO。在不同的泵速下，以及在抗凝逆转以促进ECMO氧合器内血栓形成后，连续记录血流动力学参数、ECMO回路压力以及连接到ECMO氧合器的加速度计的信号。
本研究的主要发现是在抗凝逆转后15分钟，加速度计信号的均方根（RMS）显著增加，未进行转速调整且ΔP无相应变化。与高ECMO泵速和回路流量相关的RMS变化与抗凝逆转后观察到的变化明显不同。
本项动物研究证明了基于加速度计的振动分析作为一种实时、非侵入性方法检测VV ECMO期间与抗凝逆转和潜在氧合器血栓形成相关的振动的可行性。
