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ECMO, anticoagulation

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https://www.readbyqxmd.com/read/28430304/pre-ecmo-coagulopathy-does-not-increase-the-occurrence-of-hemorrhage-during-extracorporeal-support
#1
Pilar Anton-Martin, Lakshmi Raman, Nikhil Thatte, Jefferson Tweed, Vinai Modem, Janna Journeycake
INTRODUCTION AND METHODS: Observational retrospective cohort study to evaluate the association between precannulation coagulopathy and the occurrence of hemorrhage during extracorporeal membrane oxygenation (ECMO) in neonatal and pediatric patients at a tertiary children's hospital. RESULTS: Of 241 patients supported with ECMO between January 2009 and December 2014, 175 (72.6%) had precannulation coagulation laboratory data and were included in the study. Of the eligible patients, 84 (48%) were identified as coagulopathic and 91 (52%) were noncoagulopathic...
April 20, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/28337077/antithrombin-iii-doses-rounded-to-available-vial-sizes-in-critically-ill-pediatric-patients
#2
Winifred M Stockton, Eimeira Padilla-Tolentino, Carolyn E Ragsdale
OBJECTIVES: Children have decreased levels of antithrombin III (AT III) compared to adults. These levels may be further decreased during acute illness. Administration of exogenous AT III can increase anticoagulant efficacy. The objective of this study was to evaluate AT III doses rounded to available vial sizes compared to partial vial doses in critically ill pediatric patients, including patients receiving extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT)...
January 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28328243/factors-associated-with-bleeding-and-thrombosis-in-children-receiving-extracorporeal-membrane-oxygenation-ecmo
#3
Heidi J Dalton, Ron Reeder, Pamela Garcia-Filion, Richard Holubkov, Robert A Berg, Athena Zuppa, Frank W Moler, Thomas Shanley, Murray M Pollack, Christopher Newth, John Berger, David Wessel, Joseph Carcillo, Michael Bell, Sabrina Heidemann, Kathleen L Meert, Richard Harrison, Allan Doctor, Robert F Tamburro, J Michael Dean, Tammara Jenkins, Carol Nicholson
RATIONALE: Extracorporeal membrane oxygenation (ECMO) is employed for respiratory and cardiac failure in children but is complicated by bleeding and thrombosis. OBJECTIVES: (1) Measure the incidence of bleeding (blood loss requiring transfusion or intracranial hemorrhage) and thrombosis during ECMO support; (2) identify factors associated with these complications; and (3) determine the impact of these complications on patient outcome. METHODS: Prospective, observational cohort study in pediatric, cardiac, and neonatal intensive care units in eight hospitals from December 2012 to September 2014...
March 22, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28301908/identification-of-cost-saving-opportunities-for-the-use-of-antithrombin-iii-in-adult-and-pediatric-patients
#4
Alana Ciolek, John Lindsley, Jessica Crow, Kristen Nelson-McMillan, David Procaccini
Thrombate III is a human plasma-derived antithrombin III (AT-III) often utilized in patients on extracorporeal membrane oxygenation (ECMO) with suspected AT-III-mediated heparin resistance. It is supplied as 500-U and 1000-U vials, costing US$4.66 per unit. Literature is limited in describing the clinical value of AT-III in relation to its high cost. The primary objective was to determine conditions of use and associated cost of potentially unnecessary utilization of AT-III at The Johns Hopkins Hospital. Secondary objectives included evaluating the effect of AT-III on anticoagulation parameters and the overall cost utilized and wasted on AT-III...
January 1, 2017: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/28298667/suspected-heparin-induced-thrombocytopenia-in-patients-receiving-extracorporeal-membrane-oxygenation
#5
Bhupinder Natt, Cameron Hypes, Robyn Basken, Joshua Malo, Toshinobu Kazui, Jarrod Mosier
Heparin-induced thrombocytopenia (HIT) is an immune reaction usually secondary to unfractionated heparin. Anticoagulation management is critical in patients while on extracorporeal membrane oxygenation (ECMO) to prevent thromboembolism and for the optimal functioning of the circuit. We identified five patients with respiratory failure at our hospital managed with ECMO in the last 2 years that were treated for HIT. A brief clinical course and their management are discussed. We also briefly review the literature for best evidence for management of such patients...
March 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28237895/anticoagulation-practices-and-the-prevalence-of-major-bleeding-thromboembolic-events-and-mortality-in-venoarterial-extracorporeal-membrane-oxygenation-a-systematic-review-and-meta-analysis
#6
Eric Sy, Michael C Sklar, Laurence Lequier, Eddy Fan, Hussein D Kanji
PURPOSE: The purpose was to evaluate the safety of anticoagulation in venoarterial extracorporeal membrane oxygenation (VA-ECMO). DESIGN: We performed a systematic review and meta-analysis using multiple electronic databases. Studies were from 1977 to September 27, 2016. We evaluated the effect of anticoagulation in VA-ECMO on outcomes including major bleeding, thromboembolic events, and in-hospital mortality using a random effects model meta-analysis. RESULTS: Twenty-six studies (1496 patients) were included...
June 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28225528/extracorporeal-membrane-oxygenation-after-traumatic-injury
#7
Sarwat B Ahmad, Jay Menaker, Joseph Kufera, James OʼConnor, Thomas M Scalea, Deborah M Stein
BACKGROUND: The use of extracorporeal membrane oxygenation (ECMO) for acute respiratory failure after injury is controversial and poorly described. METHODS: We reviewed our single-center experience with use of ECMO from January 2006 to November 2015 at a Level 1 primary adult resource center for trauma to determine the association of in-hospital mortality with patient demographics and clinical variables. RESULTS: Forty-six patients were treated with ECMO...
March 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28208200/massive-pulmonary-embolism-extracorporeal-membrane-oxygenation-and-surgical-pulmonary-embolectomy
#8
Aaron Weinberg, Victor F Tapson, Danny Ramzy
Massive pulmonary embolism (PE) refers to large emboli that cause hemodynamic instability, right ventricular failure, and circulatory collapse. According to the 2016 ACCP Antithrombotic Guidelines, therapy for massive PE should include systemic thrombolytic therapy in conjunction with anticoagulation and supportive care. However, in patients with a contraindication to systemic thrombolytics or in those who fail the above interventions, extracorporeal membrane oxygenation (ECMO) and/or surgical embolectomy may be used to improve oxygenation, achieve hemodynamic stability, and successfully treat massive PE...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28198716/incidence-of-cannula-associated-deep-vein-thrombosis-after-veno-venous-ecmo
#9
Jay Menaker, Ali Tabatabai, Raymond Rector, Katelyn Dolly, Joseph Kufera, Eugenia Lee, Zachary Kon, Pablo Sanchez, Si Pham, Daniel L Herr, Michael Mazzeffi, Ronald P Rabinowitz, James V OʼConnor, Deborah M Stein, Thomas M Scalea
Limited literature regarding the incidence of cannula associated deep vein thrombosis (CaDVT) following veno-venous extracorporeal membrane oxygenation (VV ECMO) exists. The purpose of this study was to identify the incidence of post decannulation CaDVT and identify any associated risk factors. Forty eight patients were admitted between August 2014 and January 2016 to the Lung Rescue Unit were included in the study. Protocolized anticoagulation levels (partial thromboplastin time 45-55 second) and routine post decannulation DVT screening were in place during the study period...
February 13, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28072940/elective-use-of-veno-venous-extracorporeal-membrane-oxygenation-and-high-flow-nasal-oxygen-for-resection-of-subtotal-malignant-distal-airway-obstruction
#10
Rkf Fung, J Stellios, P G Bannon, A Ananda, P Forrest
We describe the use of peripheral veno-venous extracorporeal membrane oxygenation (VV ECMO) and high-flow nasal oxygen as procedural support in a patient undergoing debulking of a malignant tumour of the lower airway. Due to the significant risk of complete airway obstruction upon induction of anaesthesia, ECMO was established while the patient was awake, and was maintained without systemic anticoagulation to minimise the risk of intraoperative bleeding. This case illustrates that ECMO support with high-flow nasal oxygen can be considered as part of the algorithm for airway management during surgery for subtotal lower airway obstruction, as it may be the only viable option for maintaining adequate gas exchange...
January 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28043990/low-dose-bivalirudin-anticoagulation-for-lung-transplantation-with-extracorporeal-membrane-oxygenation-in-a-patient-with-acute-heparin-induced-thrombocytopenia
#11
Andreas Koster, Jost Niedermeyer, Jan Gummert, Andre Renner
A patient scheduled for lung transplantation needed veno-venous extracorporeal membrane oxygenation (ECMO) and developed acute heparin-induced thrombocytopenia (HIT). After 21 days on ECMO support, lung transplantation was successfully performed using veno-arterial ECMO with bivalirudin anticoagulation. The target activating clotting time values of 160-180 s resulted in low bivalirudin infusion rates of 0.1 mg/kg/h. Diffuse bleeding stopped quickly after ending the continuous bivalirudin infusion.
May 1, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28030497/extra-corporeal-membrane-oxygenation-ecmo-following-traumatic-injury
#12
Sarwat Ahmad, Jay Menaker, Joseph Kufera, James O'Connor, Thomas M Scalea, Deborah M Stein
BACKGROUND: The use of ECMO for acute respiratory failure following injury is controversial and poorly described. METHODS: We reviewed our single-center experience with use of ECMO from January 2006 to November 2015 at a Level 1 primary adult resource center for trauma to determine the association of in-hospital mortality with patient demographics and clinical variables. RESULTS: 46 patients were treated with ECMO. Patients requiring venoarterial ECMO (n=7) were excluded...
December 23, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27994255/review-of-venoarterial-extracorporeal-membrane-oxygenation-and-development-of-intracardiac-thrombosis-in-adult-cardiothoracic-patients
#13
REVIEW
Brittney Williams, Wendy Bernstein
Venoarterial extracorporeal membrane oxygenation (VA ECMO) has become an indispensable treatment option for adult cardiothoracic patients experiencing acute refractory cardiogenic shock. VA ECMO is not without inherent complications as in-hospital mortality has ranged from 45% to 65% (1-3). Intracardiac thrombosis (ICT) is a rare but life-threatening complication associated with VA ECMO. VA ECMO cases complicated by ICT were searched for using the MEDLINE (PubMed and OVID), Society of Cardiovascular Anesthesiology Headquarters, and Google Scholar databases...
December 2016: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/27986695/acute-oxygenator-failure-a-new-presentation-of-heparin-induced-thrombocytopenia-in-a-patient-undergoing-venovenous-extracorporeal-membrane-oxygenation-support
#14
Robert A Ratzlaff, Juan G Ripoll, Lena L Kassab, Jose L Diaz-Gomez
A 58-year-old man with medical history of thrombocytopenia was admitted to an outside hospital for a 6-day history of worsening dyspnoea requiring mechanical ventilator support. He was transferred to our institution for extracorporeal membrane oxygenation (ECMO) given his refractory hypoxaemia. On arrival, H1N1 influenza virus was confirmed and all measures to improve oxygenation were ineffective. Thus, the decision was made to start venovenous (VV)-ECMO. Although a low baseline platelet count was recognised (60-70×10(9)/L), a sudden further decrease occurred (30×10(9)/L) and platelet transfusion was initiated...
December 16, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27956361/endothelialization-and-characterization-of-titanium-dioxide-coated-gas-exchange-membranes-for-application-in-the-bioartificial-lung
#15
Michael Pflaum, Marina Kühn-Kauffeldt, Sabrina Schmeckebier, Daniele Dipresa, Kanchan Chauhan, Bettina Wiegmann, Rolf J Haug, Jochen Schein, Axel Haverich, Sotirios Korossis
Fouling on the gas-exchange hollow-fiber membrane (HFM) of extracorporeal membrane oxygenation (ECMO) devices by blood components and pathogens represents the major hurdle to their long-term application in patients with lung deficiency or unstable hemodynamics. Although patients are treated with anticoagulants, deposition of blood proteins onto the membrane surface may still occur after few days, leading to insufficient gas transfer and, consequently, to device failure. The aim of this study was to establish an endothelial cell (EC) monolayer onto the gas-exchange membrane of an ECMO device with a view to developing a hemocompatible bioartificial lung...
December 9, 2016: Acta Biomaterialia
https://www.readbyqxmd.com/read/27881701/externally-visible-thrombus-partially-predicts-internal-thrombus-deposition-in-extracorporeal-membrane-oxygenators
#16
Charles F Evans, Tieluo Li, Vikas Mishra, Diana L Pratt, Isa S K Mohammed, Zachary N Kon, Bartley P Griffith
AIM: We sought to quantify the location and volume of thrombus in used hollow-fiber membrane oxygenators and correlate the volume of thrombus with patient demographics, flow characteristics and anticoagulation parameters. METHODS: Hollow-fiber membrane oxygenators (Quadrox D, Maquet, Rastatt, Germany) were collected after clinical use in ECMO circuits and divided into sections. Each section was digitally imaged and analyzed using ImageJ software. The location and total volume (cm(3)) of thrombus was calculated for different sections...
November 22, 2016: Perfusion
https://www.readbyqxmd.com/read/27861430/the-use-of-recombinant-antithrombin-iii-in-pediatric-and-neonatal-ecmo-patients
#17
Deanna R Todd Tzanetos, John Myers, Terri Wells, Dan Stewart, Jeffrey J Fanning, Janice E Sullivan
A retrospective review of 77 pediatric and neonatal extracorporeal membranous oxygenation (ECMO) patients who received recombinant antithrombin III (ATIII) for ATIII activity greater than 80% was conducted. Anticoagulation management was per institutional protocol. An ATIII activity greater than 80% was targeted. Diagnosis, reason for ECMO cannulation, blood product usage, heparin dosing, ATIII activity and doses, thrombotic and bleeding complications, hours on ECMO, and mortality were recorded. We calculated patient-level summary statistics and assessed differences between groups using χ tests (categorical variables) and Wilcoxon rank sum tests (continuous variables)...
January 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/27850493/855-antithrombin-iii-supplementation-for-pediatric-patients-on-ecmo-and-heparin-anticoagulation
#18
Caroline Heyrend, Jared Olson, Chanelle Stidham, Brent Kay
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27849956/315-comparison-of-routine-laboratory-measures-of-heparin-anticoagulation-for-children-on-ecmo
#19
Dipti Padhya, Michael Nemergut, Gregory Schears, Mouaz Alsawas, Wigdan Farah, Ahmed Ahmed T, Zhen Wang, Hassan Murad
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27847121/outcomes-following-routine-antithrombin-iii-replacement-during-neonatal-extracorporeal-membrane-oxygenation
#20
Brian K Stansfield, Linda Wise, P Benson Ham, Pinkal Patel, Malinda Parman, Chan Jin, Sunil Mathur, Gregory Harshfield, Jatinder Bhatia
BACKGROUND: We sought to examine the effect of routine antithrombin III (AT3) infusion on hemorrhagic and thrombotic complications, blood product utilization, and circuit lifespan in neonatal extracorporeal membrane oxygenation (ECMO). METHODS: We performed a retrospective cohort study of 162 infants placed on ECMO for hypoxic respiratory failure. Infants requiring ECMO for primary cardiac support were excluded. Demographic data, time on ECMO, blood product usage, coagulation profile, and complications were compared between 90 control patients and 72 patients treated with AT3...
October 30, 2016: Journal of Pediatric Surgery
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