Extracorporeal membrane oxygenation (ECMO) is a form of extracorporeal life support (ECLS) that can provide respiratory and circulatory support in adult and pediatric patients experiencing pulmonary or cardiopulmonary failure. According to data from the Annual international ELSO Registry Reports through January 2020 more than 129,037 patients received ECLS. Among these, 43,250 (33.5%) were neonates, 27,829 (21.6%) were pediatric, and 57,958 (44.9%) were adults. The distribution of ECLS support was 67,126 (52%) cases for pulmonary support, 46,856 (36.3%) for cardiac support, and 15,055 (11.7%) for extracorporeal cardiopulmonary resuscitation (ECPR). Among all patients, the mortality rate was 30%.
Despite the prevalence of ECMO, the complication rate remains high. The most common are hemostatic and hemorrhagic complications, which occur in ~30% of patients and require additional surgery in 17–34% of cases. All these complications could be avoided by elimination heparin. FreeFlow Medical device tested the effectiveness of its slippery omniphobic coating in vivo for potential elimination of heparin in ECMO use. Our short term heparin free study on a pig model demonstrated the promise of this technology2 in eliminating clotting without hampering gas exchange efficacy and received appreciation from Military Health System Research Symposium (MHSRS)3.
Field emission scanning electron microscopy images from membrane lungs with FFMD coating versus immobilized heparin CTRL coating. A: Representative images from the inlet face of CTRL membrane lungs with thrombus deposition, platelet activation and adhesion and fibrin network formation; (B) representative images from inlet face of FFMD-coated membrane lungs with minimal cellular deposition and clean appearance. C: CTRL and (D) FFMD coating demonstrate the clean appearance of membrane lungs sections collected at the center (left image) and outlet (right image) face of the membrane. CTRL, control; FFMD coating, FreeFlow Medical Devices slippery omniphobic coating.
Gas exchange efficiency of membrane lungs with FFMD coating versus immobilized-heparin CTRL coating. A: Lines represent mean ± standard error oxygen transfer (ml/min) measured from blood samples directly before and after passage through the membrane lung in the extracorporeal circuit. B: Bars represent means ± standard error of pCO2 for blood gases drawn from the PRE venous ECLS circuit line and POST circuit line located immediately before and after blood passage through the membrane lung. Lines represent mean ± standard error of percent decrease in pCO2 across the membrane. A two-sided test was performed with p < 0.05 accepted for significance.