Regional blood acidification inhibits coagulation during extracorporeal carbon dioxide removal (ECCO2R)

Nicolas J. Prat, Andrew D. Meyer*, Vittorio Scaravilli, Jeremy Cannon, Leopoldo C. Cancio, Andrew P. Cap, Andriy I. Batchinsky

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Consumption of platelets and coagulation factors during extracorporeal carbon dioxide removal (ECCO2R) increases bleeding complications and associated mortality. Regional infusion of lactic acid enhances ECCO2R by shifting the chemical equilibrium from bicarbonate to carbon dioxide. Our goal was to test if regional blood acidification during ECCO2R inhibits platelet function and coagulation. Methods: An ECCO2R system containing a hemofilter circulated blood at 0.25 L/min in eight healthy ewes (Ovis aries) for 36 h. Three of the sheep received ECCO2R with no recirculation compared to five sheep that received ECCO2R plus 12 h of regional blood acidification via the hemofilter, placed upstream from the oxygenator, into which 4.4 M lactic acid was infused. Blood gases, platelet count and function, thromboelastography, coagulation-factor activity, and von Willebrand factor activity (vWF:Ag) were measured at baseline, at start of lactic acid infusion, and after 36 h of extracorporeal circulation. Results: Twelve hours of regional acid infusion significantly inhibited platelet aggregation response to adenosine diphosphate; vWF; and platelet expression of P-selectin compared to control. It also significantly reduced consumption of fibrinogen and of coagulation factors V, VII, IX, compared to control. Conclusions: Regional acidification reduces platelet activation and vitamin-K-dependent coagulation-factor consumption during ECCO2R. This is the first report of a simple method that may enhance effective anticoagulation for ECCO2R.

Original languageEnglish
Pages (from-to)1181-1191
Number of pages11
JournalArtificial Organs
Issue number6
StatePublished - Jun 2022
Externally publishedYes


  • acid infusion
  • carbon dioxide removal
  • extracorporeal circulation
  • platelet activation
  • regional anticoagulation
  • ultrafiltration


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