Open AccessThe Effects of Nitric Oxide in Oxygenator Sweep Gas During Extracorporeal Circulation in a Neonatal Ovine Model
Author(s) -
Avery C. Rossidis,
Kendall M. Lawrence,
Ali Y. Mejaddam,
Aimee G. Kim,
Heron D. Baumgarten,
Barbara E. Coons,
Kathleen Young,
Stylianos Monos,
Grace Hwang,
Alan W. Flake,
MaryAnn Davey
Publication year - 2019
Publication title -
asaio journal
Language(s) - English
Resource type - Journals
eISSN - 1538-943X
pISSN - 1058-2916
DOI - 10.1097/mat.0000000000001047
Subject(s) - extracorporeal membrane oxygenation , oxygenator , medicine , extracorporeal circulation , membrane oxygenator , anesthesia , extracorporeal , methemoglobin , platelet , nitric oxide , cardiopulmonary bypass , hemoglobin
Extracorporeal membrane oxygenation is a life-saving intervention, but bleeding complications are frequent. Given that the combination of platelet loss and dysfunction is a major contributor to this acquired bleeding diathesis, efforts to combat these phenomena are of great clinical importance. In this study, we investigated the effects of nitric oxide (NO) added to the sweep gas of an extracorporeal circuit in a neonatal ovine model. Eight lambs (age 9.6 ± 1.9 days) were cannulated via the neck vessels and maintained on a pumpless arteriovenous extracorporeal membrane oxygenation circuit with blood flow restricted to 100 ml/min for 72 hours. All animals were heparinized, and a subset (n = 4) also received NO in the sweep gas at a concentration of 200 ppm. We observed no adverse effects from NO administration, and methemoglobin levels remained unchanged. Platelet counts significantly declined in all animals over the course of the study; however, mean counts were higher in the NO-treated group, and this difference was statistically significant at 24 hours (62 ± 3% vs. 32 ± 7% of baseline, P < 0.01). Likewise, mean plasma levels of beta-thromboglobulin, a marker of platelet activation, were lower in the NO-treated group, and this difference was also significant at the 24 hour time point (9.5 ± 2.2 vs. 19.7 ± 6.5 pg/mL/10 platelets, P < 0.05). We conclude that 200 ppm NO can be safely blended into the oxygenator sweep gas of a low-flow extracorporeal circuit and that it may transiently attenuate platelet consumption and activation.