Research ArticleCARBON MONOXIDE POISONING

Phototherapy and extracorporeal membrane oxygenation facilitate removal of carbon monoxide in rats

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Science Translational Medicine  09 Oct 2019:
Vol. 11, Issue 513, eaau4217
DOI: 10.1126/scitranslmed.aau4217

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Shining the light on blood

Carbon monoxide (CO) is a colorless, odorless gas that can cause severe illness and death after inhalation. After entering the bloodstream, CO replaces oxygen on hemoglobin, reducing oxygenation to peripheral tissues. When CO poisoning is associated with lung injury, treatment with 100% oxygen might not be effective. Leveraging previous studies showing that visible light was able to dissociate hemoglobin from CO, now, Zazzeron et al. developed an extracorporeal membrane oxygenator for blood exposure to visible light. The use of extracorporeal removal of CO using phototherapy, increased CO removal compared to 100% oxygen inhalation in rat model of CO poisoning and increased survival when CO poisoning was associated with lung injury.

Abstract

Inhaled carbon monoxide (CO) displaces oxygen from hemoglobin, reducing the capacity of blood to carry oxygen. Current treatments for CO-poisoned patients involve administration of 100% oxygen; however, when CO poisoning is associated with acute lung injury secondary to smoke inhalation, burns, or trauma, breathing 100% oxygen may be ineffective. Visible light dissociates CO from hemoglobin. We hypothesized that the exposure of blood to visible light while passing through a membrane oxygenator would increase the rate of CO elimination in vivo. We developed a membrane oxygenator with optimal characteristics to facilitate exposure of blood to visible light and tested the device in a rat model of CO poisoning, with or without concomitant lung injury. Compared to ventilation with 100% oxygen, the addition of extracorporeal removal of CO with phototherapy (ECCOR-P) doubled the rate of CO elimination in CO-poisoned rats with normal lungs. In CO-poisoned rats with acute lung injury, treatment with ECCOR-P increased the rate of CO removal by threefold compared to ventilation with 100% oxygen alone and was associated with improved survival. Further development and adaptation of this extracorporeal CO photo-removal device for clinical use may provide additional benefits for CO-poisoned patients, especially for those with concurrent acute lung injury.

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