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https://www.readbyqxmd.com/read/29076942/evaluation-of-systemic-heparin-versus-bivalirudin-in-adult-patients-supported-by-extracorporeal-membrane-oxygenation
#1
Theodore J Berei, Matthew P Lillyblad, Kelly J Wilson, Ross F Garberich, Katarzyna M Hryniewicz
Systemic anticoagulation is a standard of care in adult patients supported by extracorporeal membrane oxygenation (ECMO) to prevent circuit thrombosis and subsequent thromboembolic events. Unfractionated heparin has long been considered the anticoagulant of choice, but emerging evidence reports successful ECMO runs with direct thrombin inhibitors. This retrospective study sought to determine whether bivalirudin offers distinct clinical benefits as the anticoagulant of choice in ECMO. Primary end points included thrombotic events during the initial 96 hours of anticoagulation, over the course of their entire ECMO run, and at any time during the admission, as well as in-hospital and 30-day mortality...
October 23, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29042831/the-impact-of-antithrombin-iii-use-in-achieving-anticoagulant-goals-in-pediatric-patients
#2
Allison J Jones, Keliana L O'Mara, Brian J Kelly, Ravi S Samraj
OBJECTIVES: To determine the percentage of patients with >10% reduction in heparin infusion rate within 48 hours of antithrombin III (ATIII) administration. Secondary objectives include the achievement of therapeutic anticoagulation and determining the days of subtherapeutic infusion prior to supplementation. METHODS: Retrospective chart review of 12 patients younger than 18 years of age who received ATIII concentrate supplementation while on continuous heparin infusion...
September 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28966321/veno-arterial-extracorporeal-membrane-oxygenation-with-conventional-anticoagulation-can-be-a-best-solution-for-shock-due-to-massive-pe
#3
Yusuke Watanabe, Kenichi Sakakura, Naoyuki Akashi, Mami Ishikawa, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Hideo Fujita, Shin-Ichi Momomura
While most of pulmonary thromboembolism (PE) cases can be managed by thrombolytic and anticoagulation therapy, massive PE remains a life-threatening disease. Although surgical embolectomy can be a curative therapy for massive PE, peri-operative mortality for hemodynamically collapsed PE is extremely high. We present a case of hemodynamically collapsed massive PE. We avoided either thrombolytic therapy or surgical embolectomy, because the patient had recent cerebral contusion. Therefore, we managed the patient with the combination of veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and conventional anticoagulation, which dramatically improved the patient's hemodynamics...
October 21, 2017: International Heart Journal
https://www.readbyqxmd.com/read/28914339/do-we-need-randomized-clinical-trials-in-extracorporeal-respiratory-support-yes
#4
EDITORIAL
Alain Combes, Antonio Pesenti, Daniel Brodie
Extracorporeal respiratory support, also known as extracorporeal gas exchange, may be used to rescue the most severe forms of acute hypoxemic respiratory failure with high blood flow venovenous extracorporeal membrane oxygenation. Alternatively, lower flow extracorporeal carbon dioxide removal might be applied to reduce the intensity of mechanical ventilation in patients with less severe forms of the disease. However, critical reading of the results of the randomized trials and case series published to date reveals major methodological biases...
September 15, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28857905/incidence-of-cannula-associated-deep-vein-thrombosis-after-veno-venous-extracorporeal-membrane-oxygenation
#5
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 O'Connor, Deborah M Stein, Thomas M Scalea
Limited literature regarding the incidence of cannula-associated deep vein thrombosis (CaDVT) after 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 [PTT] 45-55 seconds) and routine post decannulation DVT screening were in place during the study period...
September 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28840030/veno-arterial-extracorporeal-membrane-oxygenation-without-therapeutic-anticoagulation-for-intra-operative-cardiopulmonary-support-during-lung-transplantation
#6
Ankit Bharat, Malcolm M DeCamp
Cardiopulmonary support is frequently required during lung transplantation. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been recently shown to be an acceptable and, perhaps, safer alternative to cardiopulmonary bypass machine (CBM) for lung transplantation. However, therapeutic anticoagulation used during both these techniques can cause significant bleeding diathesis, especially in the setting of re-transplantation or when severe adhesions are encountered. Technological advances have reduced the thrombogenic potential of VA-ECMO circuits and unlike CBM, VA-ECMO does not include a reservoir containing a stagnant column of blood...
July 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28800389/silicon-micropore-based-parallel-plate-membrane-oxygenator
#7
Ajay Dharia, Emily Abada, Benjamin Feinberg, Torin Yeager, Willieford Moses, Jaehyun Park, Charles Blaha, Nathan Wright, Benjamin Padilla, Shuvo Roy
Extracorporeal membrane oxygenation (ECMO) is a life support system that circulates the blood through an oxygenating system to temporarily (days to months) support heart or lung function during cardiopulmonary failure until organ recovery or replacement. Currently, the need for high levels of systemic anticoagulation and the risk for bleeding are main drawbacks of ECMO that can be addressed with a redesigned ECMO system. Our lab has developed an approach using microelectromechanical systems (MEMS) fabrication techniques to create novel gas exchange membranes consisting of a rigid silicon micropore membrane (SμM) support structure bonded to a thin film of gas-permeable polydimethylsiloxane (PDMS)...
August 11, 2017: Artificial Organs
https://www.readbyqxmd.com/read/28777135/hematologic-disorders-in-children-with-continuous-renal-replacement-therapies
#8
Celia Fabra, Sara Infante, Isabel Miras, Susana Pretus, María José Santiago, Sarah N Fernández, Jesús López-Herce
The objective of this study was to analyze hematologic disorders, coagulation disorders, and transfusion requirements in children with continuous renal replacement therapies (CRRT). This is a retrospective analysis of a prospectively collected database of children receiving CRRT between 2010 and 2015. Patient characteristics, CRRT parameters, hematologic and coagulation parameters, and need for transfusions were recorded and analyzed. We compared patients after heart surgery and noncardiac patients, those requiring extracorporeal membrane oxygenation (ECMO) and those without ECMO, and patients with different anticoagulation therapies: heparin and citrate...
August 1, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28776204/efficacy-and-safety-of-argatroban-in-patients-with-acute-respiratory-distress-syndrome-and-extracorporeal-lung-support
#9
Mario Menk, Philipp Briem, Björn Weiss, Martina Gassner, David Schwaiberger, Anton Goldmann, Christian Pille, Steffen Weber-Carstens
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) or pumpless extracorporeal lung assist (pECLA) requires effective anticoagulation. Knowledge on the use of argatroban in patients with acute respiratory distress syndrome (ARDS) undergoing ECMO or pECLA is limited. Therefore, this study assessed the feasibility, efficacy and safety of argatroban in critically ill ARDS patients undergoing extracorporeal lung support. METHODS: This retrospective analysis included ARDS patients on extracorporeal lung support who received argatroban between 2007 and 2014 in a single ARDS referral center...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28775083/rare-cause-of-respiratory-failure-in-a-young-woman-isolated-diffuse-alveolar-haemorrhage-requiring-extracorporeal-membrane-oxygenation
#10
David Kelly, Damodar Makkuni, Dhiraj Ail
A previously healthy 21-year-old young woman presented with worsening dyspnoea and haemoptysis. Imaging was suggestive of widespread pulmonary haemorrhage. There was no other organ system involvement in particular no evidence of renal involvement. Raised antimyeloperoxidase titres allowed diagnosis of isolated diffuse alveolar haemorrhage (DAH) secondary to microscopic polyangiitis (MPA). The patient rapidly deteriorated with worsening respiratory failure despite invasive mechanical ventilation and required extracorporeal membrane oxygenation (ECMO)...
August 3, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28743722/bedside-tracheostomy-on-pediatric-icu-subjects-supported-by-extracorporeal-membrane-oxygenation
#11
Stephanie P Schwartz, Desiree Bonadonna, Matthew G Hartwig, Ira M Cheifetz
BACKGROUND: Tracheostomy facilitates ambulatory extracorporeal membrane oxygenation (ECMO) as a bridge to recovery or lung transplantation in patients with respiratory failure, yet data on this procedure in this population are lacking. This report describes a series of pediatric ICU patients who had a bedside tracheostomy performed while being supported on ECMO and examines the potential impact of this procedure on active rehabilitation and sedation requirements. METHODS: This retrospective case series reviews all patients in the pediatric ICU who received a tracheostomy while being supported on ECMO at a single tertiary care center for the past 3 y...
July 25, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28704244/implementation-of-a-standardized-transfusion-protocol-for-cardiac-patients-treated-with-venoarterial-extracorporeal-membrane-oxygenation-is-associated-with-decreased-blood-component-utilization-and-may-improve-clinical-outcome
#12
Christine M Cahill, Neil Blumberg, Amy E Schmidt, Peter A Knight, Amber L Melvin, Howard T Massey, Joseph M Delehanty, Seth B Zebrak, Majed A Refaai
BACKGROUND: Extracorporeal membrane oxygenation supplies oxygenated blood to the body supporting the heart and lungs. Survival rates of 20% to 50% are reported among patients receiving ECMO for cardiac arrest, severe cardiogenic shock, or failure to wean from cardiopulmonary bypass following cardiac surgery. Bleeding is one of the most common complications in ECMO patients due to coagulopathy, systemic anticoagulation, and the presence of large bore cannulas at systemic pressure. Absence of a standardized transfusion protocol in this population leads to inconsistent transfusion practices...
July 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28701841/continuous-renal-replacement-therapy-applications-on-extracorporeal-membrane-oxygenation-circuit
#13
Ayse Filiz Yetimakman, Murat Tanyildiz, Selman Kesici, Esra Kockuzu, Benan Bayrakci
BACKGROUND AND AIMS: Continuous venovenous hemofiltration or hemodiafiltration is used frequently in pediatric patients, but experience of continuous renal replacement therapy (CRRT) application on extracorporeal membrane oxygenation (ECMO) circuit is still limited. Among several methods used for applying CRRT on ECMO patients, we aim to share our experience on inclusion of a CRRT device in the ECMO circuit which we believe is easier and safer to apply. MATERIALS AND METHODS: The data were collected on demographics, outcomes, and details of the treatment of ECMO patients who had CRRT...
June 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28683689/a-multifaceted-anticoagulation-strategy-is-needed-for-children-supported-with-ecmo
#14
Heng Fan, Jian-Hua Zhu
No abstract text is available yet for this article.
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28680640/argatroban-for-an-alternative-anticoagulant-in-hit-during-ecmo
#15
Alain Rougé, Felix Pelen, Michel Durand, Carole Schwebel
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) have become more frequently used in daily ICU practice, heparin-induced thrombocytopenia (HIT) is a rare but life-threatening complication while on extracorporeal membrane oxygenation (ECMO). HIT confirmation directly impacts on anticoagulant strategy requiring no delay unfractionated heparin discontinuation to be replaced by alternative systemic anticoagulant treatment. CASE PRESENTATION: We report two clinical cases of HIT occurring during ECMO in various settings with subsequent recovery with argatroban and provide literature review to help physicians treat HIT during ECMO in clinical daily practice...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28678046/coagulation-profile-is-not-a-predictor-of-acute-cerebrovascular-events-in-pediatric-extracorporeal-membrane-oxygenation-patients
#16
Pilar Anton-Martin, Janna Journeycake, Vinai Modem, Sailaja Golla, Lakshmi Raman, Jefferson Tweed, Cindy Darnell-Bowens
We performed a retrospective matched case-control study evaluating whether the traditional coagulation profile predicts cerebrovascular events in children on extracorporeal membrane oxygenation (ECMO) in a 71 bed intensive care unit at a tertiary children's hospital. Between 2009 and 2014, 241 neonates and children were initiated on ECMO. The cumulative 5 year incidence of intracranial hemorrhage and infarct was 9.2% and 7.9%, respectively. Thirty-six cases were individually matched 1:1 with control subjects based on age, primary diagnosis, ECMO type, cannulation site, and the presence of pre-ECMO coagulopathy...
November 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28643320/revised-protocol-of-extracorporeal-membrane-oxygenation-ecmo-therapy-in-severe-ards-recommendations-of-the-veno-venous-ecmo-expert-panel-appointed-in-february-2016-by-the-national-consultant-on-anesthesiology-and-intensive-care
#17
Romuald Lango, Zbigniew Szkulmowski, Dariusz Maciejewski, Andrzej Sosnowski, Krzysztof Kusza
Extracorporeal Membrane Oxygenation (ECMO) has become well established technique of the treatment of severe acute respiratory failure (Veno-Venous ECMO) or circulatory failure (Veno-Arterial ECMO) which enables effective blood oxygenation and carbon dioxide removal for several weeks. Veno-Venous ECMO (V-V ECMO ) is a lifesaving treatment of patients in whom severe ARDS makes artificial lung ventilation unlikely to provide satisfactory blood oxygenation for preventing further vital organs damage and progression to death...
2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/28638161/argatroban-for-heparin-induced-thrombocytopenia-during-venovenous-extracorporeal-membrane-oxygenation-with-continuous-venovenous-hemofiltration
#18
Jonathan H Sin, Natasha D Lopez
Patients receiving extracorporeal membrane oxygenation (ECMO) are at risk of circuit thrombosis due to constant contact between blood and the extracorporeal components. Unfractionated heparin has traditionally been used in this setting as a systemic form of anticoagulation to prevent thrombosis of the circuit. However, if a patient develops heparin-induced thrombocytopenia (HIT), an alternative anticoagulant would be required while the patient is maintained on ECMO. Unfortunately, the pharmacokinetic changes induced by ECMO and critical illness may potentially affect optimal drug dosing...
June 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28584789/anticoagulation-therapy-during-extracorporeal-membrane-oxygenator-support-in-pediatric-patients
#19
REVIEW
Hwa Jin Cho, Do Wan Kim, Gwan Sic Kim, In Seok Jeong
Extracorporeal membrane oxygenation (ECMO) is a salvage therapy for critically ill patients. Although ECMO is becoming more common, hemorrhagic and thromboembolic complications remain the major causes of death in patients undergoing ECMO treatments. These complications commence upon blood contact with artificial surfaces of the circuit, blood pump, and oxygenator system. Therefore, anticoagulation therapy is required in most cases to prevent these problems. Anticoagulation is more complicated in pediatric patients than in adults, and the foreign surface of ECMO only increases the complexity of systemic anticoagulation...
May 2017: Chonnam Medical Journal
https://www.readbyqxmd.com/read/28557861/heartmate-3-in-lowest-intermacs-profile-cohort-the-swiss-experience
#20
Piergiorgio Tozzi, Carlo Banfi, Kameran Ahmadov, Roger Hullin, Philippe Meyer, Raphael Giraud, Lucas Liaudet, Fabrizio Gronchi, Christophe Huber, Matthias Kirsch
New generation devices for long-term mechanical circulatory support are centrifugal pumps having fully magnetically levitated rotors to reduce blood trauma. Recently, the novel HeartMate 3 was cleared for clinical application in Switzerland. In two Swiss University Hospitals part of the "Lausanne-Geneva Transplantation Network," 10 consecutive patients in end-stage heart failure received the HeartMate 3 (Thoratec Corporation, Pleasanton, CA). Device implantation criteria were persistent low output syndrome despite optimal medical treatment...
November 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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