[Scientific and Technological Achievements Promotion] The Last Line of Defense of Life-ECMO

So far, the cumulative number of new coronary pneumonia infections worldwide has exceeded 520000, and the World Health Organization (WHO) has declared the world a new coronary pneumonia pandemic, with a sharp rise in severe, critical and fatal cases. The new coronavirus is highly contagious, long incubation period, high fatality rate, and even asymptomatic infected people, which makes the new coronavirus known as the "cunning virus", and its characteristics make it very difficult to prevent and control the epidemic itself. In this battle epidemic, there are countless white soldiers retrograde charge, guard every life; there are countless ordinary people rushed to the front line, guard every city. At the same time, countless scientific researchers have actively engaged in research related to the fight against the epidemic, providing the front-line soldiers and millions of Chinese people with the most favorable weapons to fight the epidemic.

I believe you have also heard the word ECMO from recent news reports, especially in some cases of treatment of patients with new coronary pneumonia, today's small editor for you is by our Institute of Biomedicine and Equipment (referred to as "Biomedicine Institute") is developing extracorporeal membrane oxygenation ECMO. Then let's get to know it together.

 

science and technology research and development

Extracorporeal membrane oxygenation ECMO(extracorporeal membrane oxygenation, ECMO), is a kind of extracorporeal life assistance technology, which is mainly used to partially or completely replace the heart and lung function of patients, so that the heart and lung can fully rest, so as to buy time for the treatment of primary disease. It is suitable for all kinds of cardiogenic diseases and pulmonary diseases, such as cardiogenic shock, cardiac hemorrhage trauma, severe pneumonia, acute respiratory distress syndrome, neonatal lung disease, etc.

In this new coronary pneumonia epidemic, severe and critically ill patients with severe lung lesions, respiratory failure, in the regular endotracheal intubation and breathing machine and other methods can not meet the patient's oxygenation requirements, it is necessary to apply the ECMO system, to maintain the oxygen supply of various organs, so that the patient's lungs can fully rest, for the recovery of lung function to win valuable time. As early as the beginning of the outbreak, Zhongnan Hospital of Wuhan University successfully treated a novel coronavirus patient with ECMO. ECMO has played an important role in the subsequent rescue of patients with severe and critically ill new coronary pneumonia, and this foreign word has gradually come into the general public's view.

Using ECMO to treat patients with COVID-19

On March 4, 2020, Ministry of Industry and Information Technology officials said at a press conference that since the outbreak of the new coronary pneumonia epidemic, the demand for ECMO has been increasing in Wuhan, Hubei Province, with the increase in confirmed and critically ill patients. At present, the number of ECMO in China is about 400, which are distributed in the top three hospitals and heart centers with better medical conditions. Although the country is actively purchasing ECMO systems from abroad, it is still unable to meet demand for the new coronary pneumonia epidemic.

Putting aside the public emergency of new coronary pneumonia, the National Health and Care Commission counted the number of ECMO centers and ECMO-assisted cases in China as early as 2017, and expects the number of ECMO-assisted cases to reach more than 5000 by 2020. The impact of this outbreak will greatly increase the number of patients who need ECMO assistance.

Data source: National Health Planning Commission and cardiac surgery white paper

In addition, all domestic ECMOs are imported products, and there are no similar products with independent intellectual property rights. Moreover, due to the high cost of ECMO and the scarcity of ECMO resources, not all patients in need can use it. Depending on the brand, ECMO host costs between 2 million and 3 million, but the more expensive is ECMO supplies, a set of supplies between 6 and 120000. ECMO consumables are in direct contact with human blood, so they are disposable consumables, and generally a set of consumables can be used for up to 7-14 days. The high cost of use discourages many patients.

 

science and technology innovation

In view of the high cost of ECMO without independent intellectual property rights in China, the Institute of Biomedicine is committed to the localization of ECMO equipment and consumables, so as to increase the hope of cure for more patients in need.

The main components of ECMO are the blood pump and the oxygenator (membrane lung). The blood pump can replace or partially replace the human heart to provide the power required for life activities; the oxygenator (membrane lung) can replace or partially replace the lungs of the human body to ensure oxygenation, so that the organs can operate normally.

At present, the research and development of blood pump by Biomedicine Institute is almost over, and it is also working on the related research of membrane lung and coating.

It is estimated that some small partners will ask questions when they see here ~

How does ECMO replace or partially replace our hearts and lungs to work?

The editor will explain the working principle of ECMO with everyone ~

How ECMO Works

ECMO intubates the patient's vein and then connects sterile plastic pipes to lead human venous blood out and transport it to the oxygenator (membrane lung) on ECMO for oxygenation. The oxygenator removes carbon dioxide from the blood, simultaneously increases oxygen, changes it into arterial blood, then passes through the blood pump on ECMO, and then returns it to the artery or venous cannula on the patient through the pipe to play the role of circulatory assistance and respiratory assistance.

ECMO Operation Schematic

The current oxygenator is a membrane oxygenator

Membrane oxygenators are filled with hollow fiber membranes, which are filled with a mixture of gases, while the hollow fibers are filled with blood (venous blood). The membrane has pores that allow gas molecules to pass through, while blocking water molecules and various cellular components in the blood. Due to the different partial pressures of oxygen and carbon dioxide on both sides of the hollow fiber membrane, there will be a gas diffusion exchange phenomenon, that is, the high concentration of carbon dioxide gas in venous blood diffuses into the mixture, and the oxygen in the mixture diffuses into the blood, thus completing the oxygenation process of blood in the oxygenator (membrane lung), and the dark red venous blood becomes arterial blood rich in oxygen.

Schematic diagram of gas exchange in membrane lung

The blood pump is a centrifugal magnetic coupling blood pump

Centrifugal magnetic coupling blood pump is a pump that delivers liquid by the centrifugal force generated when the impeller rotates. Up to now, the ECMO developed by Biopharmaceutical has been authorized by 8 blood pump-related patents.

Schematic diagram of blood pump

ECMO Blood Pump Authorized Patent

With the unremitting efforts of the team, the first generation blood pump prototype has completed the international standard 6-hour in vitro hemolysis experiment, and the NIH (standard hemolysis index) of the blood pump is 0.0043904g/100L, and the MIH (modified hemolysis index) is 0.0004249,The two values are far superior to international standards(International standard NIH(g/100L)= 0.02;MIH = 0.002),That is on behalf of this ECMO blood pump blood compatibility is goodTo meet the requirements of animal experiments and clinical use. On the basis of a first-generation prototype, the team developed a magnetically coupled second-generation blood pump, which can perfectly match the ECMO mainframe of foreign brands.

The ECMO second-generation blood pump will be completed in late April 2020, when a batch of blood pumps will leave the factory. The team will carry out further experimental verification on the batch of blood pumps, and the animal experiment can be declared after the verification is completed.

In vitro hemolysis experiment of the first generation prototype

Experimental data of in vitro hemolysis of the first generation prototype

Based on the development of ECMO blood pump, the team further tried to make the ECMO host domestically and completed the construction of ECMO principle machine. ECMO host contains a number of components, such as drive system, control and monitoring system, constant temperature heater, etc., of which the first two systems are the focus and difficulty of host research and development. At present, the Institute of Biomedicine has completed the technical development of the key magnetic coupling drive device in the ECMO host, and has carried out preliminary development for the blood pump control program, which can realize the control of blood pump operating parameters and real-time monitoring of operating data. The next step will be the establishment of a big data platform and the development of ECMO prototype.

In addition to independent research and development and design of ECMO, the Institute of Biomedicine also plans to establish a training team or institution related to ECMO in the later stage to increase the clinical popularity of ECMO, actively respond to the national medical strategy, strive to allow ECMO to enter the medical insurance system, and further reduce the economic burden of patients. At the same time, we will carry out research and development of terminal equipment, expand the first-mover advantage as a domestic product, and plan to build our own ECMO package production line to reduce the cycle and cost of subsequent research and development, and provide necessary conditions for related work.

ECMO principle machine

 

application value

At present, the prevention and control of the new coronary pneumonia epidemic in China is actively improving, and the number of existing confirmed patients has dropped sharply, which is the hard work of every retrograde. But at the same time, the outbreak of new crown pneumonia in countries and regions other than China is also a real concern. ECMO is the hope of patients with severe pneumonia, and it is also the gospel of many patients with cardiogenic diseases and pulmonary diseases. The development and application of domestic ECMO equipment and consumables with excellent performance and relatively low price are very important.

Demand for ECMO products has increased sharply in countries during the critical period of the global neo-coronary pneumonia outbreak, but high mainframe and consumables costs have limited the introduction of ECMO in many countries and the use of ECMO by many patients. Under the premise of localization, the cost of our products is much less than that of imported products. On the basis of benefiting domestic patients, once they enter the international market, they will be able to bring hope to more patients.

 

Institute of Biomedicine and Equipment

Relying on the strong scientific research strength and advanced technology of the School of Medicine and Pharmacy of Tsinghua University, the Institute of Biomedicine and equipment mainly focuses on four research and development directions with the policy support of the Tianjin Municipal people's Government and the strong support of the High-end equipment Research Institute of Tsinghua University. that is, health and medical equipment, drugs and diagnostic reagents, green mildew prevention and preservation, functional food and health products, and so on. The R & D personnel in the team are all high-end talents from well-known universities at home and abroad, covering biomedicine, medical equipment, bio-related fluid mechanics and mechanical design, food safety and other aspects, and have a number of patents. published more than 100 papers.

 

Technical docking

Contact: Zhao Qing

Tel: 022-84856480

Mobile phone: 17726095959

Email: zhaoqing@tsinghua-tj.org

business negotiation

Contact: Wang Zimu

Tel: 022-84856916

Mobile phone: 18811779202

Email: wangzm@tsinghua-tj.org

 

 

Source | Institute of Biomedicine and Equipment

Editor | Zhang Shu

The final interpretation right of the above related technologiesInstitute of Biomedicine and EquipmentAll