Platelet count reduction during in vitro membrane oxygenation affects platelet activation, neutrophil extracellular trap formation and clot stability, but does not prevent clotting

Perfusion, vol. 37, pp. 134–143

Abstract

INTRODUCTION: Due to improved technology and increased application the mortality during extracorporeal membrane oxygenation (ECMO) is constantly declining. Nevertheless, complications including haemorrhage or thrombus formation remain frequent. Local mitigation of coagulation within an ECMO system to prevent thrombus formation on ECMO components and optimizing systemic anticoagulation is an approach to reduce clotting and bleeding complications at once. Foreign surfaces of ECMO systems, activate platelets (PLTs), which besides their major role in coagulation, can trigger the formation of neutrophil extracellular traps (NETs) contributing to robust thrombus formation. The impact of a reduced PLT count on PLT activation and NET formation is of paramount importance and worth investigating. METHODS: test circuits for ECMO devices for 6 hours. PLT reduction was achieved by a centrifugation protocol prior to the experiments. To achieve native coagulation characteristics within the test circuits, the initial heparin dose was antagonized by continuous protamine administration. RESULTS: group showed significantly lower platelet activation, basal NET formation and limited clot stability measured via thromboelastometry. Fluorescent and scanning electron microscope imaging showed differences in clot composition. Both groups showed equal clot formation within the circuit. CONCLUSIONS: This study demonstrated that the reduction of PLTs within an ECMO system is associated with limited PLT activation and NET formation, which reduces clot stability but is not sufficient to inhibit clot formation per se.

Authors 8

1. Patrick Winnersbach corresponding Aachen Department of Anaesthesiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Anaesthesiology, University Hospital RWTH Aachen University, Aachen, Germany

2. Jan Rossaint

   University of Münster · University Hospital Münster

   Affiliation as printed

   Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany

3. Eva Miriam Buhl Aachen Institute of Pathology, Electron Microscopy Facility

   RWTH Aachen University

   Affiliation as printed

   Institute of Pathology, Electron Microscopy Facility, RWTH Aachen University, Aachen, Germany

4. Smriti Singh Aachen DWI−Leibniz Institute for Interactive Materials Aachen

   DWI – Leibniz Institute for Interactive Materials

   Affiliation as printed

   DWI−Leibniz Institute for Interactive Materials Aachen, Aachen, Germany

5. Jonas Lölsberg Aachen DWI−Leibniz Institute for Interactive Materials Aachen

   DWI – Leibniz Institute for Interactive Materials

   Affiliation as printed

   DWI−Leibniz Institute for Interactive Materials Aachen, Aachen, Germany

6. Matthias Weßling Aachen DWI−Leibniz Institute for Interactive Materials Aachen

   DWI – Leibniz Institute for Interactive Materials

   Affiliation as printed

   DWI−Leibniz Institute for Interactive Materials Aachen, Aachen, Germany

7. Rolf Rossaint Aachen Department of Anaesthesiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Anaesthesiology, University Hospital RWTH Aachen University, Aachen, Germany

8. Christian Bleilevens Aachen Department of Anaesthesiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Anaesthesiology, University Hospital RWTH Aachen University, Aachen, Germany