Gaseous Nitric Oxide-Cangrelor Combination to Prevent Clots in Extracorporeal Life Support System

• Published in: The Journal of surgical research 2024-01, Vol.293, p.468-474
• Main Authors: Ramakrishnan, Karthik, Turner, Joel, Desai, Manan, Tongut, Aybala, Nuskowski, Mark
• Format: Article
• Language: English
• Subjects: Animals; Anticoagulation; Extracorporeal life support; Extracorporeal Membrane Oxygenation; Gases; Nitric Oxide; Sheep; Thrombosis - etiology; Thrombosis - prevention & control
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2023.09.004

The objective of this study was to investigate the potential synergistic utility of a combination of gaseous nitric oxide (gNO)-intravenous Cangrelor as an effective pharmacological option for the prevention of thrombosis in an animal model of extracorporeal life support (ECLS) circuits. 10 newborn lambs were placed on ECLS. 5 of them were administered a combination of gNO and intravenous Cangrelor. The remaining 5 were not administered any anticoagulant. The primary end point was duration of ECLS without clot formation. The secondary outcome measure was the absolute maximum transmembrane pressure gradient. The mean duration of ECLS were 168 min (standard deviation 224.98 min) in the control group and 402 min (standard deviation 287.5 min) in the experimental group (P = 0.17). The peak trans-oxygenator pressure difference was 43 mm Hg (standard deviation 23 mm Hg) in the control group and 62 mm Hg (standard deviation 71 mm Hg) in the experimental group(P = 0.64). Two animals in the experimental group were supported up to 12 h without clot formation. Clot formation in the experimental group occurred after placement of the cannulae but prior to initiation of ECLS flows after cannulation. A combination of gNO and Cangrelor is prevents clot formation in an experimental animal model when administered through a clean clot-free circuit. However, the combination s ineffective when there are pre-existing clots in the circuit. A bolus of anticoagulation prior to cannulation is needed prior to testing this combination in future studies with a larger sample size.