Septic porcine blood does not further activate coagulation during in vitro membrane oxygenation.
For patients with a severe acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) represents a life-saving measure. Frequently, patients with severe ARDS also show signs of severe sepsis. As blood contact with the membrane oxygenator surface leads to adverse effects due to insufficient biocompatibility partly caused by activation of platelets, coagulation factors and leucocytes, we hypothesized that these adverse effects would be amplified if septic blood in a preactivated state came into contact with the membrane oxygenator.



In a previously established in vitro 12-h ECMO test system (mock loop), we used septic or healthy domestic pig blood to analyse coagulation and inflammatory parameters. Sepsis was induced by a caecal ligation and puncture model in pigs.



At the beginning of the mock loop experiments, the septic blood showed significantly increased thrombin-antithrombin complexes (76.9 vs 27.7 µg/l), D-dimers (1.2 vs 0.3 mg/l) and fibrinogen concentration (1.8 vs 1.5 g/l), as well as elevated extrinsic coagulation activity (shorter EXTEM-CT: 44.2 vs 57 s) and higher lactate (3.4 vs 1.5 mmol/l) and cytokine levels (interleukin-6: 827 vs 31 pg/ml) when compared with the blood from healthy animals. Despite the preactivated status of the septic blood, no further increase of coagulation activity, inflammatory response or increased oxygenator resistance was observed in comparison to the control experiments.



Septic porcine blood was not further activated due to the contact with an oxygenator, and no increased clot formation or biocompatibility problems were observed.
Department of Anesthesiology, University Hospital RWTH Aachen University, Aachen, Germany.
Christian
C
Bleilevens
Department of Anesthesiology, University Hospital RWTH Aachen University, Aachen, Germany.
Oliver
O
Grottke
Department of Anesthesiology, University Hospital RWTH Aachen University, Aachen, Germany.
Sabine
S
Groening
Department of Anesthesiology, University Hospital RWTH Aachen University, Aachen, Germany.
Markus
M
Honickel
Department of Intensive Care, University Hospital RWTH Aachen University, Aachen, Germany.
Rüdger
R
Kopp
DWI-Leibniz-Institute for Interactive Materials, RWTH Aachen University, Aachen, Germany.
Smriti
S
Singh
Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute Aachen, RWTH Aachen University, Aachen, Germany.
Jutta
J
Arens
Department of Anesthesiology, University Hospital RWTH Aachen University, Aachen, Germany.
Rolf
R
Rossaint
D000818:Animals; D001672:Biocompatible Materials; D001777:Blood Coagulation / Q000502:physiology*; D001800:Blood Specimen Collection / Q000379:methods; D016207:Cytokines / Q000097:blood; D004195:Disease Models, Animal; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D018836:Inflammation Mediators / Q000378:metabolism; D010107:Oxygenators, Membrane; D015539:Platelet Activation; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis; D034421:Sus scrofa
D001672:Biocompatible Materials; D016207:Cytokines; D018836:Inflammation Mediators
12 h; Biocompatibility; Extracorporeal membrane oxygenation (ECMO); In vitro; Sepsis