Veno‐venous extracorporeal blood phototherapy increases the rate of carbon monoxide (CO) elimination in CO‐poisoned pigs

Fischbach, Anna; Wiegand, Steffen B.; Zazzeron, L.; Traeger, Lisa; Fenza, Raffaele Di; Bagchi, Aranya; Farinelli, William A.; Franco, Walfre; Korupolu, Sandeep; Grassi, Luigi; Zadek, Francesco; Bloch, Donald B.; Anderson, R. Rox; Zapol, Warren M.

doi:10.1002/lsm.23462

Cited by 9 publications

(20 citation statements)

References 37 publications

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“…In a previous study, 15 we developed a photo-ECMO device that accelerates the removal of CO from CO-poisoned blood. The device combined the extracorporeal exposure of blood to 100% oxygen with illumination of the blood F I G U R E 1 Depiction of the hyperbaric photo-ECMO set up.…”

Section: Resultsmentioning

confidence: 99%

“…In our original, normobaric photo-ECMO device, 15 the blood compartment consisted of 15 polypropylene hollow fiber membrane mats (Oxyphan 50/280; 3 M), each 160 mm by 160 mm, which were placed on top of each other. The blood compartment was enclosed in a clear Plexiglas case.…”

Section: Development Of a Hyperbaric Photo-ecmo Devicementioning

confidence: 99%

“…A depiction of the in vitro circuit, as well as the methods used to assess and to calculate COHb reduction in one pass can be found elsewhere. 15 In this study, human whole blood (Research Blood Components) at a Hb concentration of 9.0-10.0 g/dl, anticoagulated with CPDA-1, at a blood temperature of 37°C was saturated with CO by circulating the blood at a blood flow rate of 80 ml/min through the device while it was ventilated with 2% CO diluted in air. A polyurethane sponge covered with a blood defoamer was removed from a commercially available venous reservoir (Affinity Fusion Oxygenation System; Medtronic) and attached to the inside of the blood reservoir of the in vitro circuit to avoid the formation of macroscopic gas bubbles or blood foam in the reservoir blood.…”

Section: Assessment Of Percent Cohb Reduction After a Single Blood Pa...mentioning

confidence: 99%

“…The methods used to assess and to calculate the half-life of COHb (COHb-t 1/2 ) can be found elsewhere. 15 In this study, 1 L of CO-poisoned, human whole blood (Research Blood Components) at a Hb concentration of 9.0-10.0 g/dl, at a blood temperature of 37°C and anticoagulated with CPDA-1, circulated through the photo-ECMO device while the device was ventilated with 100% oxygen at a gas flow rate of 1 L/min and at a gas pressure of 1 atm or while the device was ventilated with 100% oxygen at an increased gas pressure of 1.33 atm with and without additional exposure of the device(s) to red light. The blood flow rate was 80 ml/min during treatment of the reservoir blood with one normobaric or hyperbaric photo-ECMO device and 550 ml/min during treatment with the normobaric or hyperbaric photo-ECMO system.…”

Section: Assessment Of Half-life Of Cohb (Cohb-t 1/2 )mentioning

confidence: 99%

“…14 We combined six photo-ECMO devices in parallel and tested for the ability of the photo-ECMO "system" to treat CO-poisoned pigs. 15 Compared to pigs treated with ventilation with 100% oxygen alone, treatment with the photo-ECMO system significantly increased the rate of CO elimination. In this study, we report the development of a hyperbaric photo-ECMO device and show that, compared to ventilating the device with normobaric 100% oxygen, the use of hyperbaric oxygen significantly increased the rate of CO removal from CO-poisoned blood.…”

Section: Introductionmentioning

confidence: 95%

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Hyperbaric phototherapy augments blood carbon monoxide removal

et al. 2021

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Background and Objectives: Carbon monoxide (CO) poisoning is responsible for nearly 50,000 emergency department visits and 1200 deaths per year. Compared to oxygen, CO has a 250-fold higher affinity for hemoglobin (Hb), resulting in the displacement of oxygen from Hb and impaired oxygen delivery to tissues. Optimal treatment of CO-poisoned patients involves the administration of hyperbaric 100% oxygen to remove CO from Hb and to restore oxygen delivery. However, hyperbaric chambers are not widely available and this treatment requires transporting a CO-poisoned patient to a specialized center, which can result in delayed treatment. Visible light is known to dissociate CO from carboxyhemoglobin (COHb). In a previous study, we showed that a system composed of six photo-extracorporeal membrane oxygenation (ECMO) devices efficiently removes CO from a large animal with CO poisoning. In this study, we tested the hypothesis that the application of hyperbaric oxygen to the photo-ECMO device would further increase the rate of CO elimination. Study Design/Material and Methods: We developed a hyperbaric photo-ECMO device and assessed the ability of the device to remove CO from CO-poisoned human blood. We combined four devices into a "hyperbaric photo-ECMO system" and compared its ability to remove CO to our previously described photo-ECMO system, which was composed of six devices ventilated with normobaric oxygen. Results: Under normobaric conditions, an increase in oxygen concentration from 21% to 100% significantly increased CO elimination from CO-poisoned blood after a single pass through the device. Increased oxygen pressure within the photo-ECMO device was associated with higher exiting blood PO 2 levels and increased CO elimination. The system of four hyperbaric photo-ECMO devices removed CO from 1 L of CO-poisoned blood as quickly as the original, normobaric photo-ECMO system composed of six devices. Conclusion: This study demonstrates the feasibility and efficacy of using a hyperbaric photo-ECMO system to increase the rate of CO elimination from CO-poisoned blood. This technology could provide a simple portable emergency device and facilitate immediate treatment of CO-poisoned patients at or near the site of injury.

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Section: Resultsmentioning

confidence: 99%

Section: Development Of a Hyperbaric Photo-ecmo Devicementioning

confidence: 99%

Section: Assessment Of Percent Cohb Reduction After a Single Blood Pa...mentioning

confidence: 99%

Section: Assessment Of Half-life Of Cohb (Cohb-t 1/2 )mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

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Hyperbaric phototherapy augments blood carbon monoxide removal

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Optical, flow, and thermal analysis of a phototherapy extracorporeal membrane oxygenator for treating carbon monoxide poisoning

et al. 2023

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Background Extracorporeal membrane oxygenators (ECMO) are currently utilized to mechanically ventilate blood when lung or lung and heart function are impaired, like in cases of acute respiratory distress syndrome (ARDS). ARDS can be caused by severe cases of carbon monoxide (CO) inhalation, which is the leading cause of poison‐related deaths in the United States. ECMOs can be further optimized for severe CO inhalation using visible light to photo‐dissociate CO from hemoglobin (Hb). In previous studies, we combined phototherapy with an ECMO to design a photo‐ECMO device, which significantly increased CO elimination and improved survival in CO‐poisoned animal models using light at 460, 523, and 620 nm wavelengths. Light at 620 nm was the most effective in removing CO. Objective The aim of this study is to analyze the light propagation at 460, 523, and 620 nm wavelengths and the 3D blood flow and heating distribution within the photo‐ECMO device that increased CO elimination in CO‐poisoned animal models. Methods Light propagation, blood flow dynamics, and heat diffusion were modeled using the Monte Carlo method and the laminar Navier‐Stokes and heat diffusion equations, respectively. Results Light at 620 nm propagated through the device blood compartment (4 mm), while light at 460 and 523 nm only penetrated 48% to 50% (~2 mm). The blood flow velocity in the blood compartment varied with regions of high (5 mm/s) and low (1 mm/s) velocity, including stagnant flow. The blood temperatures at the device outlet for 460, 523, and 620 nm wavelengths were approximately 26.7°C, 27.4°C, and 20°C, respectively. However, the maximum temperatures within the blood treatment compartment rose to approximately 71°C, 77°C, and 21°C, respectively. Conclusions As the extent of light propagation correlates with efficiency in photodissociation, the light at 620 nm is the optimal wavelength for removing CO from Hb while maintaining blood temperatures below thermal damage. Measuring the inlet and outlet blood temperatures is not enough to avoid unintentional thermal damage by light irradiation. Computational models can help eliminate risks of excessive heating and improve device development by analyzing design modifications that improve blood flow, like suppressing stagnant flow, further increasing the rate of CO elimination.

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Extracorporeal membrane oxygenators with light‐diffusing fibers for treatment of carbon monoxide poisoning: Experiments, mathematical modeling, and performance assessment with unit cells

et al. 2023

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Background and Objectives: Approximately 50,000 emergency department visits per year due to carbon monoxide (CO) poisoning occur in the United States alone. Tissue hypoxia can occur at very low CO concentration exposures because CO binds with a 250-fold higher affinity than oxygen to hemoglobin. The most effective therapy is 100% hyperbaric oxygen (HBO) respiration. However, there are only a limited number of cases with ready accessibility to the specialized HBO chambers. In previous studies, we developed an extracorporeal veno-venous membrane oxygenator that facilitates exposure of blood to an external visible light source to photo-dissociate carboxyhemoglobin (COHb) and significantly increase CO removal from CO-poisoned blood (photo-extracorporeal venovenous membrane oxygenator [p-ECMO]). One objective of this study was to describe in vitro experiments with different laser wavelength sources to compare CO elimination rates in a small unit-cell ECMO device integrated with a lightdiffusing optical fiber. A second objective was to develop a mathematical model that predicts CO elimination rates in the unit-cell p-ECMO device design upon which larger devices can be based. Study Design/Material and Methods: Two small unit-cell p-ECMO devices consisted of a plastic capillary with a length and inside diameter of 10 cm and 1.15 mm, respectively. Either five (4-1 device) or seven (6-1 device) gas exchange tubes were placed in the plastic capillary and a light-diffusing fiber was inserted into one of the gas exchange tubes. Light from lasers emitting either 635 nm or 465 nm wavelengths was coupled into the light-diffusing fiber as oxygen flowed through the gas exchange membranes. To assess the ability of the device to remove CO from blood in vitro, the percent COHb reduction in a single pass through the device was assessed with and without light. The Navier Stokes equations, Carreau-Yesuda model, Boltzman equation for light distribution, and hemoglobin kinetic rate equations, including photo-dissociation, were combined in a mathematical model to predict COHb elimination in the experiments. Results: For the unit-cell devices, the COHb removal rate increases with increased 635 nm laser power, increased blood time in the device, and greater gas exchange membrane surface-to-blood volume ratio. The 6-1 device COHb half-life versus that of the 4-1 device with 4 W at 635 nm light was 1.5 min versus 4.25 min, respectively. At 1 W laser power, 635 nm and 465 nm exhibited similar CO removal rates. The COHb half-life times of the 6-1 device were 1.25, 2.67, and 8.5 min at 635 nm (4 W), 465 nm (1 W), and 100% oxygen only, respectively. The

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Veno‐venous extracorporeal blood phototherapy increases the rate of carbon monoxide (CO) elimination in CO‐poisoned pigs

Cited by 9 publications

References 37 publications

Hyperbaric phototherapy augments blood carbon monoxide removal

Hyperbaric phototherapy augments blood carbon monoxide removal

Optical, flow, and thermal analysis of a phototherapy extracorporeal membrane oxygenator for treating carbon monoxide poisoning

Extracorporeal membrane oxygenators with light‐diffusing fibers for treatment of carbon monoxide poisoning: Experiments, mathematical modeling, and performance assessment with unit cells

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