Sakurai Hironobu, Fujiwara Tatsuki, Ohuchi Katsuhiro, Hijikata Wataru, Toda Daiki, Tanaka Yui, Bumerdene Orolzod, Suzuki Sayaka, Iwanaga Takehiro, Fujita Tomoyuki
Department of Cardiovascular Surgery, Institute of Science Tokyo, Tokyo, Japan.
Department of Clinical Engineering, Juntendo University, Tokyo, Japan.
Artif Organs. 2025 Jun 27. doi: 10.1111/aor.15043.
Extracorporeal membrane oxygenation (ECMO) provides mechanical circulatory and respiratory support. However, thrombus formation in the circuit can lead to hemorrhagic complications, requiring improvements in ECMO anti-thrombogenicity. Few studies have reported the effect of pulsatile flow on thrombus formation in ECMO circuits. This study evaluated how pulsatile flow affects thrombus formation inside the membrane oxygenator.
This study was conducted in pigs (n = 5) using an experimental model in which each pig was connected to two different ECMO circuits: one with steady flow (via the jugular vein and carotid artery) and the other with pulsatile flow (via the femoral vein and artery). The pulsatile waveform was generated as an upward sinusoidal waveform added to the baseline frequency. Both circuits were set to a mean flow rate of 2 L/min and operated for 4 h without anticoagulation. Thrombus formation in the membrane oxygenators was observed during and after circulation. The thrombus area was quantified using image analysis.
All experiments were completed with stable hemodynamics. The pressure in the pulsatile circuit was confirmed to be a pulsatile waveform. The thrombus area in the steady flow circuits was 81.5%, 10.6%, 42.1%, 60.2%, and 96.7%, while those in the pulsatile flow circuits were 6.2%, 5.2%, 8.4%, 9.9%, and 65.8%, respectively. The thrombus area in the pulsatile flow circuit tended to be smaller than that in the steady flow circuit.
Pulsatile flow with a specific waveform may reduce thrombus formation in membrane oxygenators, potentially enhancing the anti-thrombogenicity of ECMO circuits.
体外膜肺氧合（ECMO）提供机械循环和呼吸支持。然而，回路中的血栓形成可导致出血并发症，需要改善ECMO的抗血栓形成能力。很少有研究报道搏动血流对ECMO回路中血栓形成的影响。本研究评估了搏动血流如何影响膜式氧合器内的血栓形成。
本研究在猪（n = 5）中使用实验模型进行，每头猪连接到两个不同的ECMO回路：一个是稳流回路（通过颈静脉和颈动脉），另一个是搏动血流回路（通过股静脉和动脉）。搏动波形被生成并添加到基线频率上，形成向上的正弦波形。两个回路均设置为平均流速2 L/min，且在不进行抗凝的情况下运行4小时。在循环期间和循环后观察膜式氧合器中的血栓形成情况。使用图像分析对血栓面积进行量化。
所有实验均在稳定的血流动力学状态下完成。确认搏动回路中的压力为搏动波形。稳流回路中的血栓面积分别为81.5%、10.6%、42.1%、60.2%和96.7%，而搏动血流回路中的血栓面积分别为6.2%、5.2%、8.4%、9.9%和65.8%。搏动血流回路中的血栓面积倾向于小于稳流回路中的血栓面积。
具有特定波形的搏动血流可能减少膜式氧合器中的血栓形成，潜在地增强ECMO回路的抗血栓形成能力。
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