Introduction. Usually, gaseous nitric oxide (NO) is supplied to the patient by inhalation, adding to the inhaled gas mixture during spontaneous breathing, or supplying it to the inspiratory part of the ventilator. It is believed that the main point of its action is the pulmonary vasculature, where it exhibits an expanding effect, thus improving the oxygenation of arterial blood and reducing the pulmonary artery pressure. However, data from recent experimental clinical studies suggest that the addition of NO directly to the gas mixture supplied to the oxygenator makes it possible to systemically deliver NO into the bloodstream and, thereby, reduce the inflammatory response of the whole body caused by the extracorporeal circuit (cardiopulmonary bypass [CPB] or extracorporeal membrane oxygenation [ECMO]). Materials and methods. The search for publications was carried out in electronic databases PubMed, EMBASE. The last search term was December 30, 2020. The search term included the following words: “nitric oxide” and “artificial circulation” or “ECMO”. Only experimental and clinical randomized controlled blinded studies were selected for inclusion in the review. Results. The article analyzes data from recent studies related to the delivery of gaseous NO to the extracorporeal circuit, among which the issues of both NO delivery into the cardiopulmonary bypass line and the systemic and organ effects of nitric oxide delivered to the circuit are considered. The cardioprotective and anti-inflammatory effects of NO supplied to the extracorporeal circulation are considered in detail, as well as its effect on the lungs and kidneys. Conclusions. Further new randomized trials are needed to determine the place of the technology for supplying gaseous nitric oxide to the line of heart-lung machines or ECMO in modern cardiac surgery.

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The aim of the study was to test the use of gaseous nitric oxide added to the extracorporeal membrane oxygenation (ECMO) system for treating critical acute heart failure after cardiac surgery.Materials and Methods. Venoarterial ECMO with addition of nitric oxide into the extracorporeal circuit was used for treating a 52-yearold patient after two-step cardiac surgery for acute dissection of the thoracic aorta and aortic valve insufficiency. After the Bentall-de Bono procedure, a technical error was revealed: that was a non-functioning anastomosis to the right coronary artery, which caused massive ischemic myocardial injury. An emergency myocardial revascularization was performed with the help of the cardiopulmonary bypass converted into ECMO; the patient's condition improved and he was transferred to the ICU.Results. Considering the sharp decrease in heart contractility and the extremely high level of myocardial damage markers, it was decided to supply nitric oxide (40 ppm) to the ECMO circuit. A positive effect was noted within 8 h from the start of the procedure: the concentration of creatine phosphokinase-MB decreased almost 4 times and the concentration of troponin I decreased twofold. The most pronounced changes were observed by the end of day 1: a significant decrease in the concentration of myocardial damage markers, a decrease in the VIS indicator by 7.5 times; an improvement in the contractile function. Further on, the patient's condition gradually stabilized: the manifestations of acute heart failure and multiple organ failure stopped, and then ECMO was discontinued after 82 h of work. The patient was decannulated and he continued to show stable hemodynamic parameters. He was discharged from the clinic on day 18 after surgery. Conclusion.For the first time, venoarterial ECMO with supply of gaseous nitric oxide into the extracorporeal circuit was used to support blood circulation after cardiac surgery. This made it possible to ensure the survival of the patient with critical ischemia-reperfusion injury developed after the surgery.