Membrane Oxygenator for Extracorporeal Blood Oxygenation

Extracorporeal blood oxygenation has become an alternative to supply O2 and remove CO2 from the bloodstream, especially when mechanical ventilation provides insufficient oxygenation. The use of a membrane oxygenator offers the advantage of lower airway pressure than a mechanical ventilator to deliver oxygen to the patient’s blood. However, research and development are still needed to find appropriate membrane materials, module configuration, and to optimize hydrodynamic conditions for achieving high efficient gas transfer and excellent biocompatibility of the membrane oxygenator. This review aims to provide a comprehensive description of the basic principle of the membrane oxygenator and its development. It also discusses the role and challenges in the use of membrane oxygenators for extracorporeal oxygenation on respiratory and cardiac failure patients.

Investigations of the characteristics and performance of modified polyethersulfones (PES) as membrane oxygenator

The modification of membrane oxygenators to minimize protein adsorption onto the surface is often accompanied by the loss of membrane performance. This study aims to explore polyethersulfone (PES) as a new material for membrane oxygenator applications and to assess its potentials. Accordingly, different modification techniques are applied to improve surface properties of PES membranes. To achieve this goal, two separate modification methods including incorporation of TiO2 into the membrane matrix as well as grafting polyethylene glycol (PEG) through oxygen plasma treatment are developed and the effects are examined. The results reveal that protein adsorption to the nanocomposite membrane containing 0.50 wt. % TiO2 and the grafted membrane decreased by 47 and 31%, respectively. In terms of performance, permeability and oxygen transfer rate of all modified membranes exceeded 808 GPU and 2.7 × 10−4 mol·m−2·s−1, respectively. Contact angle analysis revealed signs of hydrophilicity enhancement of membranes after modifications. The findings suggest that upon proper modifications, membranes based on PES could be considered as promising candidates for membrane oxygenator applications and deserves further investigations.

Microstructured Hollow Fiber Membranes: Potential Fiber Shapes for Extracorporeal Membrane Oxygenators

Extracorporeal membrane oxygenators are essential medical devices for the treatment of patients with respiratory failure. A promising approach to improve oxygenator performance is the use of microstructured hollow fiber membranes that increase the available gas exchange surface area. However, by altering the traditional circular fiber shape, the risk of low flow, stagnating zones that obstruct mass transfer and encourage thrombus formation, may increase. Finding an optimal fiber shape is therefore a significant task. In this study, experimentally validated computational fluid dynamics simulations were used to investigate transverse flow within fiber packings of circular and microstructured fiber geometries. A numerical model was applied to calculate the local Sherwood number on the membrane surface, allowing for qualitative comparison of gas exchange capacities in low-velocity areas caused by the microstructured geometries. These adverse flow structures lead to a tradeoff between increased surface area and mass transfer. Based on our simulations, we suggest an optimal fiber shape for further investigations that increases potential mass transfer by up to 48% in comparison to the traditional, circular hollow fiber shape.

Water as a Blood Model for Determination of CO2 Removal Performance of Membrane Oxygenators

CO2 removal via membrane oxygenators has become an important and reliable clinical technique. Nevertheless, oxygenators must be further optimized to increase CO2 removal performance and to reduce severe side effects. Here, in vitro tests with water can significantly reduce costs and effort during development. However, they must be able to reasonably represent the CO2 removal performance observed with blood. In this study, the deviation between the CO2 removal rate determined in vivo with porcine blood from that determined in vitro with water is quantified. The magnitude of this deviation (approx. 10%) is consistent with results reported in the literature. To better understand the remaining difference in CO2 removal rate and in order to assess the application limits of in vitro water tests, CFD simulations were conducted. They allow to quantify and investigate the influences of the differing fluid properties of blood and water on the CO2 removal rate. The CFD results indicate that the main CO2 transport resistance, the diffusional boundary layer, behaves generally differently in blood and water. Hence, studies of the CO2 boundary layer should be preferably conducted with blood. In contrast, water tests can be considered suitable for reliable determination of the total CO2 removal performance of oxygenators.

Extracorporeal membrane oxygenation and V/Q ratios: an ex vivo analysis of CO2 clearance within the Maquet Quadrox-iD oxygenator

While hypercapnia is typically well treated with modern membrane oxygenators, there are cases where respiratory acidosis persists despite maximal extracorporeal membrane oxygenation support. To better understand the physiology of gas exchange within the membrane oxygenator, CO2 clearance within an adult Maquet Quadrox-iD oxygenator was evaluated at varying blood CO2 tensions and V/Q ratios in an ex vivo extracorporeal membrane oxygenation circuit. A closed blood-primed circuit incorporating two Maquet Quadrox-iD oxygenators in series was attached to a Maquet PLS Rotaflow pump. A varying blend of CO2 and air was connected to the first oxygenator to provide different levels of pre-oxygenator blood CO2 levels (PvCO2) to the second oxygenator. Varying sweep gas flows of 100% O2 were connected to the second oxygenator to provide different V/Q ratios. Exhaust CO2 was directly measured, and then VCO2 and oxygenator dead space fraction (VD/VT) were calculated. VCO2 increased with increasing gas flow rates with plateauing at V/Q ratios greater than 4.0. Exhaust CO2 increased with PvCO2 in a linear fashion with the slope of the line decreasing at high V/Q ratios. Oxygenator dead space fraction varied with V/Q ratio—at lower ratios, dead space fraction was 0.3-0.4 and rose to 0.8-0.9 at ratios greater than 4.0. Within the Maquet Quadrox-iD oxygenator, CO2 clearance is limited at high V/Q ratios and correlated with elevated oxygenator dead space fraction. These findings have important implications for patients requiring high levels of extracorporeal membrane oxygenation support.