Carmeda surface heparinization in neonatal ECMO systems: long-term experiments in a sheep model

Abstract

The thromboresistance in three Carmeda (Stockholm, Sweden) heparin- coated neonatal ECMO systems with a runtime of 45, 56 and 96 hours, respectively, and three noncoated systems with a runtime of 12, 42 and 66 hours, respectively, were compared using a sheep model. The flow rate was 200 ml/min and the activated clotting time (ACT) was kept at approximately 120 seconds. At the end of the experiment, the heparin-coated systems only contained minimal clotting while the controls showed major clotting in the entire system. Fibrin monomers were not detected until after 24 hours in the heparin- coated group, but demonstrated within 60 minutes in the noncoated group.

It is concluded that the Carmeda heparin coating has a thromboresistant effect, and may be used to reduce the need for systemic heparinization in ECMO treatment of neonates.

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References

Neonatal ECMO Registry Report. Ann Arbor, MI: University of Michigan Medical Center, January 1994.

Sell LL , Cullen ML , Whittlesey GC et al. Hemorrhagic complications during extracorporeal membrane oxygenation. J Pediatr Surg 1986; 21: 1087-91.

Bui KC , Laclair P. , Vanderkerhove J. , Bartlett RH ECMO in premature infants. Trans ASAIO 1991; 37: 54-59.

Taylor GA , Short BL , Fitz CR Imaging of cerebrovascular injury in infants treated with extracorporeal membrane oxygenation. J Pediatr 1989 ;114:635-39.

Mottaghy K. , Oedekoven B. , Pöppel K. et al. Heparin free long-term extracorporeal circulation using bioactive surfaces. Trans ASAIO 1989 ; 35: 635-37.

Bindslev L. , Eklund J. , Norlander O. et al. Treatment of acute respiratory failure by extracorporeal carbon dioxide elimination performed with a surface heparinized artificial lung. Anaesthesiology 1987; 67: 117-20.

Larm O. , Larsson R. , Olsson P. A new non-thrombogenic surface prepared by selective covalent binding of heparin via a modified reducing terminal residue. Biomat Med Dev Art Org 1983; 11 : 161-72.

Kodama K. , Pasche B. , Olsson P. et al. Antithrombin III binding to surface immobilized heparin and its relation to F Xa inhibition. Thromb Haemost 1987; 58:1064-67.

Frenckner B. , Palmer K. , Ehren H. , Gouda I , Larm O. Surface heparinized neonatal ECMO-circuit - An experimental animal study. Perfusion 1992; 7 : 47-51.

10.

Clauss A. Gerinungsphysiologische Schnellmethode zur Betimmung des Fibrinogens . Acta Haematologica 1957;17: 237-46.

11.

Lesko SM , Mitchell AA , Epstein MF , Louik C. , Giacoia GP , Shapiro S. Heparin use as a risk factor for intraventricular haemorrhage in low-birth-weight infants. N Engl J Med 1986; 314: 1156-60.

12.

Inancio J. , Bindslev L. , Nilsson E. , Gouda I. , Olsson P. Extracorporeal elimination of carbon dioxide using a surface heparinized vein-to-vein bypass system. EUROXY Workshop on Design and Techniques of Extracorporeal Gas Exchange, Paris, 20-21 June, 1985.