24 October 2025

Reimagining ECCO₂R Safety: Nitric Oxide Offers a Novel Path to Reduced Clot Risk

Geneva researchers investigate a breakthrough method to limit circuit thrombosis without systemic anticoagulation

In battlefield trauma, where every second and every intervention counts, ensuring safe and effective extracorporeal life support (ECLS) is vital. A recent study from Geneva’s Autonomous Reanimation and Evacuation Research Institute & Innovation Center (AREVA) explores a critical advancement: can we anticoagulate the circuit — not the patient?

Published in ASAIO Journal, the study titled “Anticoagulate the Circuit, Not the Patient: Nitric Oxide Reduces Thrombus Formation During Extracorporeal Carbon Dioxide Removal” evaluated a nitric oxide (NO)-enhanced ECCO₂R system as an alternative to systemic anticoagulation using a 72-hour swine model. The findings showed significantly reduced clot formation in the ECCO₂R circuit while avoiding the risks of bleeding and other complications associated with traditional heparin-based strategies.

Why It Matters for Military Medicine

Anticoagulation during extracorporeal support poses a delicate balance, especially in combat or trauma environments where bleeding risk is already high. The AREVA team’s investigation into an NO-generating ECCO₂R system addresses a key operational challenge: reducing thrombotic complications without systemic heparin.

This innovation could lead to safer prolonged use of ECLS in deployed environments or damage-control resuscitation, providing a lifeline for patients who can’t tolerate anticoagulants due to injury, coagulopathy, or resource constraints.

Key Findings

• Thrombus coverage was significantly reduced (10.2% in NO group vs. 15.2% in control; p = 0.03)
• No systemic heparin was needed in the NO group which minimized the bleeding risk
• No compromise in oxygenator performance or systemic health indicators
• All NO-treated circuits remained patent throughout the 72-hour study

 

The study also confirmed that methemoglobin levels remained within safe ranges, and no animals in the NO group developed adverse events related to nitric oxide exposure.

Behind the Research

This complex translational study was led by Dr. Teryn Roberts, with co-authors Yanyi Zang, George T. Harea, Daniel S. Wendorff, Brendan M. Beely, Leopoldo C. Cancio, Andrea Selkow Wallish, Tracey V. Wick, Melissa M. Reynolds, and Dr. Andriy I. Batchinsky, director of the AREVA Institute at Geneva.

This multi-day model featured continuous intensive care and sophisticated biomarker monitoring, providing a highly controlled environment to evaluate systemic versus circuit-specific coagulation effects.

Bridging Innovation and Operational Readiness

Geneva’s AREVA team continues to push the boundaries of battlefield medical innovation, translating promising lab science into potential real-world solutions for prolonged casualty care. As the military faces increasing demand for low-resource, damage-control approaches to life support, technologies like NO-enhanced ECCO₂R may provide safer, more portable solutions for stabilizing critically ill patients.

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