1
|
Goh T, Gao L, Singh J, Totaro R, Carey R, Yang K, Cartwright B, Dennis M, Ju LA, Waterhouse A. Platelet Adhesion and Activation in an ECMO Thrombosis-on-a-Chip Model. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2401524. [PMID: 38757670 DOI: 10.1002/advs.202401524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/03/2024] [Indexed: 05/18/2024]
Abstract
Use of extracorporeal membrane oxygenation (ECMO) for cardiorespiratory failure remains complicated by blood clot formation (thrombosis), triggered by biomaterial surfaces and flow conditions. Thrombosis may result in ECMO circuit changes, cause red blood cell hemolysis, and thromboembolic events. Medical device thrombosis is potentiated by the interplay between biomaterial properties, hemodynamic flow conditions and patient pathology, however, the contribution and importance of these factors are poorly understood because many in vitro models lack the capability to customize material and flow conditions to investigate thrombosis under clinically relevant medical device conditions. Therefore, an ECMO thrombosis-on-a-chip model is developed that enables highly customizable biomaterial and flow combinations to evaluate ECMO thrombosis in real-time with low blood volume. It is observed that low flow rates, decelerating conditions, and flow stasis significantly increased platelet adhesion, correlating with clinical thrombus formation. For the first time, it is found that tubing material, polyvinyl chloride, caused increased platelet P-selectin activation compared to connector material, polycarbonate. This ECMO thrombosis-on-a-chip model can be used to guide ECMO operation, inform medical device design, investigate embolism, occlusion and platelet activation mechanisms, and develop anti-thrombotic biomaterials to ultimately reduce medical device thrombosis, anti-thrombotic drug use and therefore bleeding complications, leading to safer blood-contacting medical devices.
Collapse
Affiliation(s)
- Tiffany Goh
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Heart Research Institute, Newtown, NSW, 2042, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
- The University of Sydney Nano Institute, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Lingzi Gao
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Heart Research Institute, Newtown, NSW, 2042, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
- The University of Sydney Nano Institute, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Jasneil Singh
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Heart Research Institute, Newtown, NSW, 2042, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
- The University of Sydney Nano Institute, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Richard Totaro
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Intensive Care Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
| | - Ruaidhri Carey
- Intensive Care Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
| | - Kevin Yang
- Intensive Care Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
| | - Bruce Cartwright
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Anaesthetics Department, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, 2050, Australia
| | - Mark Dennis
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Cardiology Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
| | - Lining Arnold Ju
- Heart Research Institute, Newtown, NSW, 2042, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
- The University of Sydney Nano Institute, The University of Sydney, Sydney, NSW, 2006, Australia
- School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Darlington, NSW, 2008, Australia
| | - Anna Waterhouse
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
- The University of Sydney Nano Institute, The University of Sydney, Sydney, NSW, 2006, Australia
| |
Collapse
|
2
|
Das S, Gupta S, Das D, Dutta N. Basics of extra corporeal membrane oxygenation: a pediatric intensivist's perspective. Perfusion 2021; 37:439-455. [PMID: 33765881 DOI: 10.1177/02676591211005260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Extra Corporeal membrane oxygenation (ECMO) is one of the most advanced forms of life support therapy in the Intensive Care Unit. It relies on the principle where an external artificial circuit carries venous blood from the patient to a gas exchange device (oxygenator) within which blood becomes enriched with oxygen and has carbon dioxide removed. The blood is then returned to the patient via a central vein or an artery. The goal of ECMO is to provide a physiologic milieu for recovery in refractory cardiac/respiratory failure. The technology is not a definitive treatment for a disease, but provides valuable time for the body to recover. In that way it can be compared to a bridge, where patients are initiated on ECMO as a bridge to recovery, bridge to decision making, bridge to transplant or bridge to diagnosis. The use of this modality in children is not backed by a lot of randomized controlled trials, but the use has increased dramatically in our country in last 10 years. This article is not intended to provide an in-depth overview of ECMO, but outlines the basic principles that a pediatric intensive care physician should know in order to manage a kid on ECMO support.
Collapse
Affiliation(s)
- Shubhadeep Das
- Department of Pediatric Cardiac Intensive Care, NH Narayana Superspeciality Hospital, Howrah, West Bengal, India
| | - Sandip Gupta
- Department of Pediatric Intensive Care, Aster CMI Hospital, Bangalore, Karnataka, India
| | - Debasis Das
- Department of Cardiac Surgery, NH Narayana Superspeciality Hospital, Howrah, West Bengal, India
| | - Nilanjan Dutta
- Department of Cardiac Surgery, NH Narayana Superspeciality Hospital, Howrah, West Bengal, India
| |
Collapse
|