Project Details
Projekt
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
Carbon monoxide (CO) intoxication is a leading cause of poisoning related death and results in more than 20,000 visits to emergency departments in the United States each year. The mortality rate from CO poisoning is 1 – 3% and the rate of morbidity is as high as 40%. Patients who survive CO poisoning suffer from neurologic and cardiac sequelae, which have been shown to increase the long-term mortality. If one considers both hospital costs and lost earnings, the economic burden of CO intoxication is approximately 1.3 billion dollars each year. The toxicity associated with inhalation of CO is caused by the impairment of oxygen delivery to, and inhibition of ATP generation in, mitochondria. Compared to oxygen, CO has a 250-fold higher affinity for the binding site in hemoglobin (Hb) resulting in tissue hypoxia. The main goal of treatment for CO poisoning is to remove CO from the body as quickly as possible by oxygen. Through competitive binding of oxygen to Hb, CO is displaced from Hb in the lung and then exhaled. The CO t1/2 while breathing room air, 100% oxygen or hyperbaric oxygen is approximately 5 hours, 2 hours and 30 minutes respectively. Unfortunately, hyperbaric oxygen therapy is often delayed, because of the need to transport the patient to medical centers with specialized equipment. Furthermore, hyperbaric oxygen may be complicated by barotrauma, oxygen toxicity, seizures and pulmonary edema. Because of these limitations to the current treatment of patients with CO poisoning, new therapies are needed to improve outcomes.The overall objective of the current proposal is to design and develop a large artificial lung unit that combines the principles of CO photodissociation and extra-corporeal oxygenation to increase the rate of CO removal from patients with CO poisoning. In preliminary studies led by Drs. Zazzeron and Zapol, we designed and built a small photo- extracorporeal CO removal (ECCOR) device that increased the rate of CO removal from CO-poisoned rats. However, the prototypic device will require modifications to permit treatment of larger animals and ultimately patients with CO poisoning. The required changes include larger surface areas for gas exchange and illumination and the ability to accommodate a higher blood flow rate. After in-vitro testing of oxygenating performance and CO removal, the ability of the photo-ECCOR device to remove CO from blood will be tested in a sheep model of CO poisoning.By the end of this research fellowship, I anticipate that we will have a prototypic veno-venous photo-ECCOR device that can efficiently remove CO from the blood of large animals, including humans.
DFG Programme
Research Fellowships
International Connection
USA
