Portable NO Generation for Heparin-Free Extracorporeal Life Support in Combat Casualties
Abstract
This proposal addresses the call for Multi-Domain Lifesaving Trauma Innovations Award proposals to address new and emerging challenges in future military conflicts with near-peer adversaries. Specifically, in Focus Area 1 – Prolonged and En Route Care – we address the call for “innovative capabilities to enable the provision of damage control interventions closer to the point of need,” and “Innovative organ support capabilities in a forward environment…”. Additionally, we address the call for “Innovative management of severely injured Warfighters with complex polytrauma conditions in the prehospital environments” from Focus Area 2 – Battlefield Resuscitation for Immediate Stabilization of Combat Casualties. It is expected that future military operations will occur under conditions leading to inability for early evacuation of casualties, thus creating the need to develop life preservation strategies that could sustain life in severely injured casualties with single and multiorgan failure for up to 72 hours after injury before evacuation is possible. This delay in evacuation and subsequent care in place has been termed prolonged field care (PFC). To meet these and other challenges inherent in PFC, development of simplified lifesaving solutions and extracorporeal life support (ECLS) technologies will be needed. ECLS will prolong survivability from devastating combined polytrauma injuries, assure sustainment of vital functions for hours-to-days until aeromedical evacuation can take place, reduce mortality, and increase lethality of our Forces. Current ECLS technology requires the administration of blood thinners, usually a drug called heparin, to prevent the patient’s blood from forming clots when it contacts the foreign surfaces that make up the ECLS device. This is because formation of clots within the device can prevent blood from flowing through the device, alter the function/performance of the device, and/or damage the patient’s blood causing internal clotting/further injury to the patient. This requirement severely limits the number of patients that ECLS may be applied to. Specifically in combat-wounded Soldiers who often have tissue trauma and bleeding complications, the use of heparin or any blood thinners could cause them to have excessive blood loss; and for this reason, many of these patients currently cannot receive ECLS therapy, even though it could be lifesaving. Our goal in this proposal is to test a novel approach to prevent clot formation in the ECLS circuit without heparin by using nitric oxide (NO). NO is a gas that is known to inhibit the activity of platelets, which are key mediators of clot formation within the blood. In healthy blood vessels, NO is constantly produced to prevent clots from forming unnecessarily. NO gas can be added into the ECLS circuit to prevent clot formation on the device surfaces while minimizing the risk of bleeding to the patient that occurs with the use of heparin. Bleeding risk is reduced with NO because the effect it has on platelets is reversible and is only sustained for a few seconds. In this way, NO will provide local anticoagulation at the site of administration (in the ECLS device), without sustained effects in the body. Currently, it is not realistic to use NO gas during ECLS for combat wounded and in deployed environments because it is supplied in large, heavy cylinders that could not feasibly be available in an austere medical environment and are very expensive. For this reason, in this study the NO gas will be supplied using a novel, portable NO generator that can produce NO gas with nitrogen and oxygen from the air using a special electrode. Using this NO generator, we will develop a practical and safe solution to prevent clot formation during ECLS in trauma patients without the use of heparin. ECLS is a potent, lifesaving intervention in the most severely ill that would be available to more patients if the risk of clotting/bleeding complication
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010833
Entities
People
- Andriy I. Batchinsky
Organizations
- Geneva Foundation
- United States Army