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ECMO, anticoagulation

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https://www.readbyqxmd.com/read/29788841/heparin-induced-thrombocytopenia-complicating-extracorporeal-membrane-oxygenation-support-in-pediatric-patients-review-of-the-literature-and-alternative-anticoagulants
#1
Uri Pollak
Heparin-induced thrombocytopenia (HIT) is a prothrombotic, immune-mediated complication of unfractionated heparin (UFH) and low molecular weight heparin therapy. HIT is characterized by moderate thrombocytopenia 5-10 days after initial heparin exposure, detection of platelet-activating anti-platelet factor 4/heparin antibodies and an increased risk of venous and arterial thrombosis. Extracorporeal membrane oxygenation (ECMO) is a form of mechanical circulatory support used in critically ill patients with respiratory or cardiac failure...
May 2018: Perfusion
https://www.readbyqxmd.com/read/29788836/intracranial-hemorrhage-in-adults-on-ecmo
#2
Yiorgos Alexandros Cavayas, Lorenzo Del Sorbo, Eddy Fan
RATIONALE: Extracorporeal membrane oxygenation (ECMO) use has exploded over the last decade. However, it remains invasive and associated with significant complications, including tamponade, infection, thrombosis, gas embolism and bleeding. The most dreaded complication is intracranial hemorrhage (ICH). In this article, we review the literature on the incidence, diagnosis, risk factors, pathophysiology, prognosis, prevention and management of ICH in adults on ECMO. MAIN FINDINGS: We found a high incidence of ICH in the literature with a poor prognosis...
May 2018: Perfusion
https://www.readbyqxmd.com/read/29779622/anticoagulation-during-ecmo-in-neonatal-and-paediatric-patients
#3
Rebecca Barton, Vera Ignjatovic, Paul Monagle
Extracorporeal Membrane Oxygenation (ECMO) is a form of Extracorporeal Life Support (ECLS) which is used frequently in the paediatric and neonatal setting to support either the pulmonary, or both the pulmonary and cardiac systems. Management of ECMO requires the use of systemic anticoagulation to prevent patient and circuit based thrombosis, which in turn increases the risk of haemorrhage. A number of coagulation tests, laboratory and point of care based, are used to monitor anticoagulation, however the evidence for correlation of the test results with level of anticoagulant and clinical outcomes in children remains poor...
May 8, 2018: Thrombosis Research
https://www.readbyqxmd.com/read/29775606/ecmo-for-acute-respiratory-distress-syndrome-after-thoracoabdominal-aortic-aneurysm-repair
#4
Subhasis Chatterjee, William Mulvoy, Ourania A Preventza, Kim I de la Cruz, Scott A LeMaire, Joseph S Coselli
Acute respiratory distress syndrome (ARDS) after thoracoabdominal aortic aneurysm (TAAA) repair poses a formidable challenge. Despite conventional maneuvers in the operating room, perioperative ARDS may require extracorporeal membrane oxygenation (ECMO). We present 3 cases of successful ECMO for ARDS after TAAA repair and discuss management of anticoagulation and cerebrospinal fluid drains. Our experience suggests that ECMO is reasonable in selected patients after TAAA repair.
May 15, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29768983/anticoagulation-monitoring-under-ecmo-support-a-comparative-study-between-the-activated-coagulation-time-and-the-anti-xa-activity-assay
#5
Clément Delmas, Aemilia Jacquemin, Fanny Vardon-Bounes, Bernard Georges, Felipe Guerrero, Nicolas Hernandez, Bertrand Marcheix, Thierry Seguin, Vincent Minville, Jean-Marie Conil, Stein Silva
PURPOSE: Extra Corporeal Membrane Oxygenation (ECMO) is used in cases of severe respiratory and/or circulatory failure over periods of several days to several weeks. Its circuitry requires a closely monitored anticoagulation therapy that is empirically supported by activated clotting time (ACT)-a method often associated with large inter- and intraindividual variability. We aimed to compare the measurement of heparin activity with ACT and the direct measurement of the heparin activity (anti-Xa) in a large ECMO population...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29746314/impact-of-anticoagulation-and-circuit-technology-on-complications-during-extracorporeal-membrane-oxygenation
#6
Robert A Niebler, Hinah Parker, George M Hoffman
The objective of this study is to evaluate the impact a change in anticoagulation protocol and circuit technology had on bleeding and thrombotic complications in patients supported on extracorporeal membrane oxygenation (ECMO). A retrospective review at a tertiary, academic pediatric intensive care unit was undertaken. The anticoagulation protocol changed from targeting an activated clotting time (ACT) to anti-Xa level. Significant changes in the ECMO circuit were undertaken concurrently. One-hundred and fifty-two ECMO runs in 129 patients in the ACT target group were compared with 122 ECMO runs in 101 patients in the anti-Xa target group...
May 8, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29730125/triage-and-optimization-a-new-paradigm-in-the-treatment-of-massive-pulmonary-embolism
#7
Chetan Pasrija, Aakash Shah, Praveen George, Anthony Kronfli, Maxwell Raithel, Francesca Boulos, Mehrdad Ghoreishi, Gregory J Bittle, Michael A Mazzeffi, Lewis Rubinson, James S Gammie, Bartley P Griffith, Zachary N Kon
BACKGROUND: Massive pulmonary embolism (PE) remains a highly fatal condition. Although venoarterial extracorporeal membrane oxygenation (VA-ECMO) and surgical pulmonary embolectomy in the management of massive PE have been reported previously, the outcomes remain less than ideal. We hypothesized that the institution of a protocolized approach of triage and optimization using VA-ECMO would result in improved outcomes compared with historical surgical management. METHODS: All patients with a massive PE referred to the cardiac surgery service between 2010 and 2017 were retrospectively reviewed...
April 7, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29662809/validation-of-nafamostat-mesilate-as-an-anticoagulant-in-extracorporeal-membrane-oxygenation-a-large-animal-experiment
#8
Sung Joon Han, Woosik Han, Hee-Jung Song, Cuk-Seong Kim, Seong-Mok Jeong, Min Woong Kang
Background: Unfractionated heparin is commonly used for anticoagulation in extracorporeal membrane oxygenation (ECMO). Several studies have shown that nafamostat mesilate (NM) has comparable clinical outcomes to unfractionated heparin. This study compared anticoagulation with NM and heparin in a large-animal model. Methods: Beagle dogs (n=8; weight, 6.5-9 kg) were placed on venovenous ECMO. Blood samples were taken every hour and the following parameters were compared: hemoglobin level, activated partial thromboplastin time (aPTT), thromboelastography (TEG) data, platelet function, and inflammatory cytokine levels...
April 2018: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29605270/pumpless-arteriovenous-extracorporeal-membrane-oxygenation-a-novel-mode-of-respiratory-support-in-a-lamb-model-of-congenital-diaphragmatic-hernia
#9
Emily A Partridge, Marcus G Davey, Matthew Hornick, Kevin C Dysart, Aliza Olive, Robert Caskey, James T Connelly, Holly L Hedrick, William H Peranteau, Alan W Flake
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is commonly required in neonates with congenital diaphragmatic hernia (CDH) complicated by pulmonary hypertension (PH). ECMO carries significant risk, and is contraindicated in the setting of extreme prematurity or intracranial hemorrhage. Pumpless arteriovenous ECMO (P-ECMO) may represent an alternative for respiratory support. The present study summarizes our initial experience with P-ECMO in a lamb model of CDH. STUDY DESIGN: Surgical creation of CDH was performed at 65-75days' gestation...
March 9, 2018: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29572101/impact-of-connecting-continuous-renal-replacement-therapy-to-the-extracorporeal-membrane-oxygenation-circuit
#10
Christian de Tymowski, Mathieu Desmard, Brice Lortat-Jacob, Quentin Pellenc, Soleiman Alkhoder, Arezki Alouache, Benedicte Fritz, Philippe Montravers, Augustin Pascal
Purpose Continuous veno-venous haemofiltration (CVVH) directly connected to extracorporeal membrane oxygenation (ECMO) may ensure better blood flow and allow prolonged circuit life. The objective of this study was to assess circuit life of CVVH connected to ECMO and to a dialysis catheter. Materials and Methods In this prospective observational study, patients receiving CVVH via ECMO were compared to time-matched patients receiving CVVH via a conventional dialysis catheter. CVVH circuit life and the safety and efficacy of the two CVVH procedures were analysed...
March 20, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29529977/routine-ct-scanning-of-patients-retrieved-to-a-tertiary-centre-on-veno-venous-extracorporeal-membrane-oxygenation-a-retrospective-risk-benefit-analysis
#11
Kate M Richmond, Katharine G Warburton, Simon J Finney, Sachin Shah, Benjamin A J Reddi
INTRODUCTION: Comprehensive clinical examination can be compromised in patients on veno-venous extracorporeal membrane oxygenation (VV-ECMO). Adjunctive diagnostic imaging strategies range from bedside imaging only to routine computed tomography (CT). The risk-benefit of either approach remains to be evaluated. Patients retrieved to the Royal Brompton Hospital (RBH) on VV-ECMO routinely undergo admission CT imaging of head, chest, abdomen and pelvis. This study aimed to identify how frequently changes in therapy or adverse events could be attributed to routine CT scanning...
March 1, 2018: Perfusion
https://www.readbyqxmd.com/read/29435994/evaluation-of-the-novel-centrifugal-pump-capiox-sl-in-chronic-large-animal-experiments
#12
Kei Iizuka, Nobumasa Katagiri, Yoshiaki Takewa, Tomonori Tsukiya, Toshihide Mizuno, Yosuke Itamochi, Kouko Kumano, Eisuke Tatsumi
In the development of a new device for extracorporeal circulation, long-term durability and biocompatibility are required. The CAPIOX SL Pump (SL pump, Terumo Corporation, Tokyo, Japan), which is a centrifugal pump using a two-pivot bearing, was developed with the hope of suppressing pump thrombus formation around the bearings. This study aimed to evaluate the in vivo performance of the SL pump in the condition assumed severe clinical situation for long-term extracorporeal membrane oxygenation (ECMO) support...
February 12, 2018: Artificial Organs
https://www.readbyqxmd.com/read/29356355/improving-hemocompatibility-of-membranes-for-extracorporeal-membrane-oxygenators-by-grafting-nonthrombogenic-polymer-brushes
#13
Fabian Obstals, Mariia Vorobii, Tomáš Riedel, Andres de Los Santos Pereira, Michael Bruns, Smriti Singh, Cesar Rodriguez-Emmenegger
Nonthrombogenic modifications of membranes for extracorporeal membrane oxygenators (ECMOs) are of key interest. The absence of hemocompatibility of these membranes and the need of anticoagulation of patients result in severe and potentially life-threatening complications during ECMO treatment. To address the lack of hemocompatibility of the membrane, surface modifications are developed, which act as barriers to protein adsorption on the membrane and, in this way, prevent activation of the coagulation cascade...
March 2018: Macromolecular Bioscience
https://www.readbyqxmd.com/read/29340875/thromboelastography-based-anticoagulation-management-during-extracorporeal-membrane-oxygenation-a-safety-and-feasibility-pilot-study
#14
Mauro Panigada, Giacomo E Iapichino, Matteo Brioni, Giovanna Panarello, Alessandro Protti, Giacomo Grasselli, Giovanna Occhipinti, Cristina Novembrino, Dario Consonni, Antonio Arcadipane, Luciano Gattinoni, Antonio Pesenti
BACKGROUND: There is no consensus on the management of anticoagulation during extracorporeal membrane oxygenation (ECMO). ECMO is currently burdened by a high rate of hemostatic complications, possibly associated with inadequate monitoring of heparin anticoagulation. This study aims to assess the safety and feasibility of an anticoagulation protocol for patients undergoing ECMO based on thromboelastography (TEG) as opposed to an activated partial thromboplastin time (aPTT)-based protocol...
January 16, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29336832/anticoagulation-in-neonatal-ecmo
#15
REVIEW
Aditi Kamdar, Natalie Rintoul, Leslie Raffini
Despite advances made in technology and neonatal intensive care, the rate of hemorrhagic and thrombotic complications remains unacceptably high in patients undergoing extracorporeal membrane oxygenation (ECMO) and these complications negatively impact morbidity and mortality. Management of anticoagulation in neonates who have a developing hemostatic system is vastly different from adults and poses unique challenges. Variation in practice among ECMO centers regarding anticoagulation monitoring and titration reflects the lack of high-quality evidence...
March 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/29312706/hemorrhage-under-veno-venous-extracorporeal-membrane-oxygenation-in-acute-respiratory-distress-syndrome-patients-a-retrospective-data-analysis
#16
Stefan Kreyer, Thomas Muders, Nils Theuerkauf, Juliane Spitzhüttl, Torsten Schellhaas, Jens-Christian Schewe, Ulf Guenther, Hermann Wrigge, Christian Putensen
Background: Despite being still invasive and challenging, technical improvement has resulted in broader and more frequent application of extracorporeal membrane oxygenation (ECMO), to prevent hypoxemia and to reduce invasiveness of mechanical ventilation (MV). Heparin-coated ECMO-circuits are currently standard of care, in addition to heparin based anticoagulation (AC) regimen guided by activated clotting time (ACT) or activated partial thromboplastin time (aPTT). Despite these advances, a reliable prediction of hemorrhage is difficult and the risk of hemorrhagic complication remains unfortunately high...
December 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29284886/monitored-anesthesia-care-for-the-acute-ischemic-stroke-patient-with-end-stage-pulmonary-disease
#17
Kevin C Lee, Brian C Lee, Steven E Miller
The majority of patients who suffer acute ischemic stroke (AIS) from large vessel occlusion are at a significant risk for disability or death. Because patients on veno-arterial extracorporeal membrane oxygenation (VA ECMO) are therapeutically anticoagulated, intravenous recombinant tissue plasminogen activator is contraindicated. For AIS management, these patients must undergo emergent intra-arterial therapy. Presented is a patient on VA ECMO who subsequently suffered a large vessel embolic stroke requiring emergent surgical intervention...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29222320/anticoagulation-with-vads-and-ecmo-walking-the-tightrope
#18
REVIEW
Leslie Raffini
The evolution of devices for mechanical circulatory support (MCS), including ventricular assist devices (VADs) for patients with heart failure and extracorporeal membrane oxygenation (ECMO) for patients with acute cardiac or respiratory failure, has improved survival for subsets of critically ill children and adults. The devices are intricate and complex, allowing blood to bypass the heart or lungs (or both). As blood flows through these artificial devices, normal hemostasis is disrupted, coagulation is promoted, and in the absence of anticoagulation, a thrombus may form in the device, resulting in device failure or embolic stroke...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29189422/extracorporeal-membrane-oxygenation-in-premature-infants-with-congenital-diaphragmatic-hernia
#19
Milenka Cuevas Guamán, Adesola C Akinkuotu, Stephanie M Cruz, Pamela A Griffiths, Stephen E Welty, Timothy C Lee, Oluyinka O Olutoye
Prematurity and low birth weight have been exclusion criteria for extracorporeal membrane oxygenation (ECMO); however, these criteria are not evidence based. With advances in anticoagulation, improved technology, and surgical expertise, it is difficult to deny a potential therapy based on these criteria alone. We report the outcome of three neonates who were ineligible based on traditional criteria but were offered ECMO as a life-saving measure. We highlight the interdisciplinary nature of modern decision-making...
November 14, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29174781/utilization-of-veno-arterial-extracorporeal-membrane-oxygenation-for-massive-pulmonary-embolism
#20
Chetan Pasrija, Anthony Kronfli, Praveen George, Maxwell Raithel, Francesca Boulos, Daniel L Herr, James S Gammie, Si M Pham, Bartley P Griffith, Zachary N Kon
BACKGROUND: The management of massive pulmonary embolism remains challenging, with a considerable mortality rate. Although veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for massive pulmonary embolism has been reported, its use as salvage therapy has been associated with poor outcomes. We reviewed our experience utilizing an aggressive, protocolized approach of VA-ECMO to triage, optimize, and treat these patients. METHODS: All patients with a massive pulmonary embolism who were placed on VA-ECMO, as an initial intervention determined by protocol, were retrospectively reviewed...
February 2018: Annals of Thoracic Surgery
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