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The oxygenation membrane, a core material of extracorporeal membrane oxygenation (ECMO), is facing challenges in balancing anti-plasma leakage, gas exchange efficiency, and hemocompatibility. Here, inspired by the asymmetric structural features of alveolus pulmonalis, a novel triple-functional membrane for blood oxygenation with a Janus architecture is proposed, which is composed of a hydrophobic polydimethylsiloxane (PDMS) layer to prevent plasma leakage, an ultrathin polyamide layer to enhance gas exchange efficiency with a CO 2 :O 2 permeance ratio of ≈10.7, and a hydrophilic polyzwitterionic layer to improve the hemocompatibility. During the simulated ECMO process, the Janus oxygenation membrane exhibits excellent performance in terms of thrombus formation and plasma leakage prevention, as well as adequate O 2 transfer rate (17.8 mL min -1 m -2 ) and CO 2 transfer rate (70.1 mL min -1 m -2 ), in comparison to the reported oxygenation membranes. This work presents novel concepts for the advancement of oxygenation membranes and demonstrates the application potential of the asymmetric triple-functional Janus oxygenation membrane in ECMO., (© 2023 Wiley-VCH GmbH.)

Nafamostat mesylate (NM) affects coagulation and fibrinolysis and impedes obesity-associated protein demethylase activity, which regulates Na + /K + transport properties and the NF-κB signaling pathway. NM significantly decreases macrophage, neutrophil, and T lymphocyte infiltration, thereby reducing inflammation and apoptosis after reperfusion and promoting recovery in patients with severe conditions such as near-fatal asthma and cardiac arrest. Extracorporeal life support (ECLS) devices are used for cardiac and/or pulmonary support as a bridge to recovery, decision, surgery, or transplant in patients with refractory cardio-circulatory or respiratory diseases and provide essential opportunities for organ support and patient survival. However, they can lead to some potential adverse events such as hemorrhage and thrombosis. NM provides a sustained innate immune response of coagulation and anti-inflammation in extracorporeal circuits, principally due to its activation of the contact and complement systems. Heparin is the main anticoagulant used in extracorporeal circuits; however, it may cause massive bleeding and heparin-induced thrombocytopenia. Although no antidote is available, NM has a very short half-life of approximately 8-10 min and might have positive effects on patients who require coagulation and anti-inflammation. NM has been used for anticoagulation in continuous renal replacement therapy, extracorporeal membrane oxygenation, hemodialysis, and left ventricular assist devices. In this review, we focused on the pharmacology, monitoring parameters, and considerations for the special use of NM in patients receiving ECLS. Our findings suggest that systemic anticoagulation with NM during ECLS might be a feasible and safe alternative with several advantages for critically ill patients with high-risk bleeding and might improve their prognosis., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022. Published by Elsevier B.V.)

Introduction: Near fatal asthma is a life-threatening disorder that requires mechanical ventilation. Near fatal asthma and COPD with sudden cardiac arrest can worsen the outcomes. Previous studies demonstrated that ECMO is a live-saving measure for near fatal asthma that does not respond to traditional treatment., Case Study: A patient with near fatal asthma (NFA) and COPD presented with high airway resistance, life-threatening acidemia and severe hypoxemia that failed to respond to conventional therapy. His hospital course was complicated by sudden cardiac arrest when preparing to initiate V-V mode extracorporeal membrane oxygenation (ECMO). The mode immediately changed from V-V to V-A, then to V-AV and finally to V-V mode in order to improve cardiac function and promote recovery of lung function., Results: On the sixth day, ECMO was removed and on the ninth day, he was extubated and transferred to the ward. Finally, the patient was discharged home on the nineteenth day after admission to be followed up in the pulmonary clinic., Conclusions: The early application of ECMO and mode changing plausibly resulted in dramatic improvement in gas exchange and restoration of cardiac function. This case illustrates the critical role of ECMO mode changing as salvage therapy in NFA and COPD with sudden cardiac arrest.

Acute myocardial infarction (AMI) and acute massive pulmonary embolism can be characterized by no pulse electrical activity. Patients of cardiac arrest (CA) with no pulse electrical activity have a high mortality rate before the cause was corrected. Extracorporeal membrane oxygenation (ECMO), as a kind of artificial heart-lung support organ, provides treatment for CA patients. A case of massive pulmonary embolism similar to AMI was treated in the Third Central Hospital of Tianjin, who received interventional thrombolysis assisted by ECMO. Through the review of the overall development of the case, we aim to broaden the diagnosis and treatment of CA patients with no pulse electrical activity, and to improve the understanding of the complications secondary to ECMO.

Oxygenation membranes in extracorporeal membrane oxygenation (ECMO) with excellent gas permeability, good hemocompatibility and durable resistance to plasma leakage is the key to achieve long-term and efficient blood oxygenation. This study put forward surface segregation strategy in thermally induced phase separation (TIPS) of poly (4-methyl-1-pentene) (PMP) membranes to realize the in-situ surface modification. Heterostructured PMP membranes with hydrophilic hemocompatible surface and hydrophobic body were obtained by migration of hydrophilic segments of the amphiphilic block copolymer Pluronic F127 to the surface in their preparation process. The hydrophilic surface could effectively improve hemocompatibility of membranes through hydration layer effect and steric hindrance effect, also reduce platelet adhesion significantly, and prolong the coagulation time of the four coagulation items within the normal physiological range of human body. When adding 10 wt% F127, the membrane exhibited an optimum CO 2 permeance of ∼11461 GPU and O 2 permeance of ∼13335 GPU, respectively, and an optimized blood oxygenation performance in vitro with O 2 flux of 122.9 ml min−1 m−2 and CO 2 flux of 129.2 ml min−1 m−2, and the asymmetric structure ensures resistance to plasma leakage for more than two months, that showed great application potential. Besides, preparation of hollow fiber membranes based on surface segregation was also explored, aiming to realize the enhanced performance and large-scale preparation of PMP oxygenation membranes. The membranes prepared in this work exhibited an outstanding performance when applied in blood oxygenation, showing great application potentials. [Display omitted] • PMP-F127 membranes were fabricated via surface segregation. • The membrane has a hemocompatible skin layer and an asymmetric support layer. • The membrane shows good gas permeability and long-term stability. • A large-scale PMP/F127-10 hollow fiber oxygenation membranes were prepared. [ABSTRACT FROM AUTHOR]