Platelet protection during ECMO. In vitro studies

Abstract

Extracorporeal membrane oxygenation (ECMO) is a complex technique for providing life support in severe respiratory and cardiac failure. ECMO is however associated with several side effects where bleeding complications are frequently observed. The contact between blood and the artificial surface of the ECMO system induces an overall activation of the hemostatic system. The objective of the present work were to:(I) evaluate the effect of different ECMO systems on platelet activation and consumption, and (II) to evaluate the effect of a hemofilter added to the ECMO system on cytokine removal as well as platelet activation and consumption. (III) To evaluate the effect of epoprostenol on platelet consumption, (IV) to evaluate the effect of a combination of platelet protective drugs, namely nitric oxide, epoprostenol and nafamostat mesilate on platelet activation and consumption during experimental ECMO. We found in our in vitro model for extra corporeal membrane oxygenation that different ECMO systems induce different degree of platelet activation. That a hemofilter added to the extra corporeal circuit reduces levels of circulating proinflammatory cytokines with out affecting platelet activation or consumption. Epoprostenol significantly reduces platelet consumption during experimental ECMO and the combination of Nitric oxide, Epoprostenol and Nafamostat mesilate results in reduced platelet activation and consumption in this in vitro model, as well as a reduced activation of the coagulation system.