| Abstract Scope |
Extracorporeal Life Support (ECLS) has long been a valuable means of providing respiratory support for patients with acute respiratory distress syndrome. Permanent support of patients with chronic lung disease, however, has not been feasible, due primarily to the negative consequences of blood-biomaterial interactions. Protein adsorption and activation leads to device coagulation, patient bleeding, thromboembolism, and organ dysfunction. However, recent developments in surface-focused anticoagulation suggest that biomaterial surfaces might be passivated to enable longer, safer application of ECLS. Zwitterionic surface coatings reduce protein adsorption and conformational changes that activate the coagulation cascade and platelets, and selective inhibitors of the intrinsic coagulation cascade are capable of potent biomaterial anticoagulation without causing patient tissue bleeding. Further development of these technologies is necessary to optimize and evaluate their application for periods of weeks to months. However, they offer sufficient promise to suggest that permanent, home-based respiratory support might be feasible in the future. |