What question did this study set out to answer?

This research aims to assess the effectiveness of nitric oxide-releasing extracorporeal circuits in reducing thrombosis during venovenous extracorporeal life support.

June 11, 2026

Nitric Oxide–Releasing Surfaces Reduce Thrombosis in Venovenous Extracorporeal Life Support: A 5 day Long Ovine Study

Key Points

This research aims to assess the effectiveness of nitric oxide-releasing extracorporeal circuits in reducing thrombosis during venovenous extracorporeal life support.
Conducted a 5-day ovine model with 15 sheep divided into three groups of five: control, sham, and NO-releasing ECC.
Monitored various parameters including hemodynamics, ECC performance, and coagulation markers without systemic anticoagulation.
Adjusted extracorporeal life support flow over defined time intervals.
NO-releasing ECC prolonged survival to ~120 hours with lower device resistance and plasma-free hemoglobin levels.
All groups maintained activated clotting times (ACTs) of less than 200 seconds; NO-releasing ECCs exhibited superior performance in reducing anticoagulation needs.
Final MetHb levels were less than 5%, indicating minimal nitric oxide toxicity.

Abstract

Extracorporeal life support (ECLS) components designed to reduce clot formation have been developed, but thrombosis remains a significant challenge, requiring systemic anticoagulation. To address this, we evaluated a nitric oxide (NO) releasing extracorporeal circuit (ECC) in a 5 day ovine venovenous ECLS model without systemic anticoagulation. Fifteen sheep, weighing 40-52 kg, were instrumented and assigned to three groups (n = 5 each): 1) Control- "naïve" ECC without anticoagulation; 2) Sham-CarboSil-coated ECC; and 3) NOSA-NO-releasing ECC+100 ppm NO in the sweep gas. Animals were monitored until meeting two of the three end-point criteria defined by device resistance five times baseline, greater than 50% decrease in blood flow after RPM adjustments, or post-oxygenator SO2 less than 95%. Extracorporeal Life Support flow was adjusted from 1 L/min (0-24 h), 0.75 L/min (25-48 h) to 0.5 L/min (49 h to study end). Data collected included hemodynamics, ECC performance, coagulation markers, cellular activity, and NO toxicity. The NO-releasing ECC prolonged survival to ~120 h with lower resistance and plasma-free hemoglobin, stable coagulation, and final MetHb levels less than 5%. Activated clotting times (ACTs) were less than 200 s in all groups. These findings suggest that NO-releasing ECCs in a highly translational preclinical ovine model may improve ECLS safety while reducing reliance on systemic anticoagulation.

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