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This article is part of the Research Topic

Hemostasis in ECMO and VAD

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Front. Med. | doi: 10.3389/fmed.2018.00321

Novel Surfaces in Extracorporeal membrane oxygenation circuits

Andrea Ontaneda1 and  Gail M. Annich1*
  • 1Hospital for Sick Children, Canada

The balance between systemic anticoagulation and clotting is challenging. In normal hemostasis, the endothelium regulates the balance between anticoagulant and prothrombotic systems. It becomes particularly more challenging to maintain this physiologic hemostasis when we are faced with extracorporeal life support therapies, where blood is continuously in contact with a foreign extracorporeal circuit surface predisposing a prothrombotic state. The blood-surface interaction during extracorporeal life support therapies requires the use of systemic anticoagulation to decrease the risk of clotting. Unfractionated heparin is the most common anticoagulant agent widely used in this setting. New trends include the use of direct thrombin inhibitor agents for systemic anticoagulation; and surface modifications that aim to overcome the blood-biomaterial surface interaction by modifying the hydrophilicity or hydrophobicity of the polymer surface; and coating the circuit with substances that will mimic the endothelium or anti-thrombotic agents. To improve hemocompatibility in an extracorporeal circuit, replication of the anti-thrombotic and anti-inflammatory properties of the endothelium is ideal. Surface modifications can be classified into three major groups: biomimetic surfaces (heparin, nitric oxide and direct thrombin inhibitors); biopassive surfaces [phosphorylcholine, albumin and poly- 2-methoxyethylacrylate]; and endothelialization of blood contacting surface.
The focus of this paper will be to review both present and future novel surface modifications that can obviate the need for systemic anticoagulation during extracorporeal life support therapies.

Keywords: Extracorporeal circuit, Anticoagualtion, blood-surface interaction, surface coating, Nitric Oxide, Endothelium

Received: 13 Aug 2018; Accepted: 30 Oct 2018.

Edited by:

Jun Teruya, Texas Children's Hospital, United States

Reviewed by:

Wei Li, Marshall University, United States
Miguel A. Cruz, Baylor College of Medicine, United States  

Copyright: © 2018 Ontaneda and Annich. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: MD. Gail M. Annich, Hospital for Sick Children, Toronto, M5G 1X8, Ontario, Canada, gail.annich@sickkids.ca