7317 2024 eng 11 article Frontiers 0 -- -- -- Extracorporeal membrane oxygenation (ECMO) was established as a treatment for severe cardiac or respiratory disease. Intra-device clot formation is a common risk. This is based on complex coagulation phenomena which are not yet sufficiently understood. The objective was the development and validation of a methodology to capture the key properties of clots deposed in membrane lungs (MLs), such as clot size, distribution, burden, and composition. One end-oftherapy PLS ML was examined. Clot detection was performed using multidetector computed tomography (MDCT), microcomputed tomography (μCT), and photography of fiber mats (fiber mat imaging, FMI). Histological staining was conducted for von Willebrand factor (vWF), platelets (CD42b, CD62P), fibrin, and nucleated cells (4′, 6-diamidino-2-phenylindole, DAPI). The three imaging methods showed similar clot distribution inside the ML. Independent of the imaging method, clot loading was detected predominantly in the inlet chamber of the ML. The μCT had the highest accuracy. However, it was more expensive and time consuming than MDCT or FMI. The MDCT detected the clots with low scanning time. Due to its lower resolution, it only showed clotted areas but not the exact shape of clot structures. FMI represented the simplest variant, requiring little effort and resources. FMI allowed clot localization and calculation of clot volume. Histological evaluation indicated omnipresent immunological deposits throughout the ML. Visually clot-free areas were covered with leukocytes and platelets forming platelet-leukocyte aggregates (PLAs). Cells were embedded in vWF cobwebs, while vWF fibers were negligible. In conclusion, the presented methodology allowed adequate clot identification and histological classification of possible thrombosis markers such as PLAs. Frontiers in Medicine 10.3389/fmed.2024.1416319 publish false true Creative Commons - CC BY - Namensnennung 4.0 International Maria Stella Wagner Michael Kranz Lars Krenkel Daniel Pointner Maik Foltan Matthias Lubnow Karla Lehle eng uncontrolled ECMO eng uncontrolled membrane lung eng uncontrolled µCT eng uncontrolled MDCT eng uncontrolled shear induced clotting eng uncontrolled vWF eng uncontrolled histological evaluation Fakultät Maschinenbau Research Center of Biomedical Engineering - RCBE Research Center of Health Sciences and Technology - RCHST Gold Open Access- Erstveröffentlichung in einem/als Open-Access-Medium Research Center for Artificial Intelligence - RCAI Krenkel, Lars (Prof. Dr.), Publikationen - Labor Biofluidmechanik Gesundheit und Soziales