Heparin-Free Extracorporeal Life Support for Point-of-Need Treatment of Single and Multiorgan Failure
Abstract
Three out of every 10 service Members wounded in the recent conflicts in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) that require a mechanical ventilator to support their breathing will develop a severe lung problem called ARDS – acute respiratory distress syndrome. Those that do not get lung injury also frequently require mechanical ventilation and get ARDS later due to lung injury by the ventilator. ARDS requires turning down the support of the breathing machine to protect the lungs. That means that the patient is not breathing as deep or as often, which leads to more carbon dioxide accumulation in their blood, causing derangement of physiologic balance. To counterbalance this problem, we will use a special device called an extracorporeal life support system (ECLS). This device is connected to the patient via a plastic tube placed into the major vein in the neck. The blood is diverted outside the body through this plastic tube and is channeled through a canister that performs as an artificial lung. This artificial lung removes carbon dioxide and adds oxygen to the blood, thus reducing the need to do that via the mechanical ventilator. Thus, combination of the treatment via coupling the mechanical ventilator and the ECLS system will reduce lung injury by the ventilator at the same time as it will directly support and replace the gas exchange by the native lung. A major hurdle in implementation of this strategy is the fact that it is started late after trauma because of a concern that when blood comes in contact with the plastic tubing of the ECLS system it will clot and causes increased inflammation. Because of this, ECLS systems used today are used very late in the disease as a last resort intervention and require systemic administration of an anticlotting agent – heparin. Unfortunately, use of heparin must be avoided during trauma as it prevents blood from clotting but at the same time worsens bleeding. This proposal addresses this problem by testing a new type of combination coating on the ECLS system. This combination coating contains compounds that release a chemical compound naturally occurring in the blood, nitric oxide (NO). NO reduces activation of the coagulation system and prevents clotting. The other component of this combination is a slippery, non-adhesive compound infused into the plastic that prevents clot formation and bacterial growth. We will test this coated membrane and circuit lung in both a laboratory with blood, in small animals, and in a hospital-like intensive care unit (ICU) setting using a combat-relevant trauma model in anesthetized and sleeping large animals. We will conduct tests to determine exactly how all of the parts of the blood that make clots react to this coating as well as measure release of NO into the blood. These tests will not only confirm if the coating is safe to blood, which our preliminary tests have already shown, but will tell us what changes, if any, we can expect in patients that this coating might be used with. Based on preliminary data, we expect the coating to perform safely and permit early utilization of ECLS as a life-saving therapy in trauma patients and combat casualties that otherwise die early after severe injuries. Our team includes: top critical-care physicians with extensive experience in treating trauma and severe lung in both combat support and civilian hospitals; physician-scientists who have developed intricate large animal models of trauma, and lung injury, using state-of-the-art ICU technologies; and basic scientists who have discovered new molecules to study within the body that highlight the patterns of damage, and may guide future study of how a damaged body acts. Our team has been using and studying membrane lungs for 16 years, and we have unique experience in how to utilize this technology. We also know how to cause, study, and treat severe injuries to test exactly how treatments and devices work. Thi
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910401
Entities
People
- Andriy I. Batchinsky
Organizations
- Geneva Foundation
- United States Army