Electrochemical VWF Biosensors Based on Two-Step Synthesized rGO@AuNPs Nanocomposites for Early Prediction of ECMO Bleeding Complications.

Extracorporeal membrane oxygenation (ECMO) is a life-saving technology for patients with severe cardiopulmonary failure. However, bleeding complications remain a major clinical challenge, largely due to high shear stress-induced Von Willebrand factor (VWF) dysfunction. Existing methods often lack timeliness and sensitivity for VWF detection in early bleeding risk assessment. Here, we proposed an electrochemical biosensor that combined Two-Step Synthesized graphene oxide-gold nanoparticles (rGO@AuNPs) nanocomposites modified screen-printed electrodes and a miniaturized wireless communication circuit for point-of-care testing (POCT) of VWF levels. The introduction of rGO@AuNPs significantly enhanced the sensing performance, achieving a low limit of detection of 0.39 pg/mL for VWF within 15 min. Moreover, there are Pearson correlation coefficients of 0.926 and 0.974 between the VWF biosensor and ELISA for porcine models and clinical samples. Notably, VWF degradation was associated with high shear stress, and VWF depletion was observed at the same time of APTT prolongation, suggesting its utility as a biomarker for bleeding risk. Its rapid, portable, and cost-effective design supports POCT, offering a promising tool for early monitoring and intervention in ECMO-related bleeding.