Veno-venous extracorporeal blood phototherapy as treatment for carbon monoxide poisoning

• Applicant: Dr. Anna Fischbach
• Subject Area: Anaesthesiology
• Term: from 2019 to 2021
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 425351607

Final Report Abstract

In a previous study, we combined a membrane oxygenator with phototherapy at 623 nm to produce a “mini” photo‐ECMO (extracorporeal membrane oxygenation) device, which improved CO elimination and survival in CO‐poisoned rats. The objective of this study was to develop a larger photo‐ECMO device (“maxi” photo‐ ECMO) and to test its ability to remove CO from a porcine model of CO poisoning. The maxi photo‐ECMO device was able to fully oxygenate the blood after a single pass through the device. Compared to ventilation with 100% oxygen alone, illumination with red light together with 100% oxygen was twice as efficient in removing CO from blood. Changes in gas flow rates did not alter CO elimination in one pass through the device. Increases in irradiance up to 214 mW/cm 2 were associated with an increased rate of CO elimination. The photo‐ECMO device was effective over a range of blood flow rates and with higher blood flow rates, more CO was eliminated. A photo‐ECMO system composed of six photo‐ECMO devices removed CO faster from CO‐poisoned blood than a single photo‐ECMO device. In a CO‐poisoned pig, the photo‐ECMO system increased the rate of CO elimination without significantly increasing the animal's body temperature or causing hemodynamic instability. As a conclusion, we developed a photo‐ECMO system and demonstrated its ability to remove CO from CO‐poisoned 45‐kg pigs. Technical modifications of the photo‐ECMO system, including the development of a compact, portable device, will permit treatment of patients with CO poisoning at the scene of their poisoning, during transit to a local emergency room, and in hospitals that lack HBO facilities.

Publications

• Phototherapy and extracorporeal membrane oxygenation facilitate removal of carbon monoxide in rats. Sci Transl Med. 2019 Oct 9;11(513):eaau4217
  Zazzeron L, Fischbach A, Franco W, Farinelli WA, Ichinose F, Bloch DB, Anderson RR, Zapol WM
  
• Antimicrobial effects of nitric oxide in murine models of Klebsiella pneumonia. Redox Biol. 2021 Feb;39:101826
  Wiegand SB, Traeger L, Nguyen HK, Rouillard KR, Fischbach A, Zadek F, Ichinose F, Schoenfisch MH, Carroll RW, Bloch DB, Zapol WM
  
• Intratracheal injection of nitric oxide, generated from air by pulsed electrical discharge, for the treatment of pulmonary hypertension in awake ambulatory lambs. Nitric Oxide. 2020 Apr 1;97:11-15
  Yu B, Zadek F, Fischbach A, Wiegand SB, Berra L, Bloch DB, Zapol WM
  
• A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects. J Vis Exp. 2021 May 4;(171)
  Pinciroli R, Traeger L, Fischbach A, Gianni S, Morais CCA, Fakhr BS, Di Fenza R, Robinson D, Carroll R, Zapol WM, Berra L
  
• Hyperbaric phototherapy augments blood carbon monoxide removal. Lasers Surg Med. 2022 Mar;54(3):426- 432
  Fischbach A, Traeger L, Farinelli WA, Ezaka M, Wanderley HV, Wiegand SB, Franco W, Bagchi A, Bloch DB, Anderson RR, Zapol WM
  
• Veno-venous extracorporeal blood phototherapy increases the rate of carbon monoxide (CO) elimination in CO-poisoned pigs. Lasers Surg Med. 2022 Feb;54(2):256-267
  Fischbach A, Wiegand SB, Zazzeron L, Traeger L, di Fenza R, Bagchi A, Farinelli WA, Franco W, Korupolu S, Arens J, Grassi L, Zadek F, Bloch DB, Rox Anderson R, Zapol WM