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ECMO, anticoagulation

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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
#1
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
#2
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.
January 2, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28030497/extra-corporeal-membrane-oxygenation-ecmo-following-traumatic-injury
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
https://www.readbyqxmd.com/read/27837164/evaluation-of-a-pharmacy-managed-heparin-protocol-for-extracorporeal-membrane-oxygenation-patients
#12
Kalliopi Fitousis, Robin Klasek, Phillip E Mason, Faisal Masud
INTRODUCTION: Unfractionated heparin is the preferred anticoagulant in extracorporeal membrane oxygenation (ECMO) patients. However, there is a lack of consensus on its titration and monitoring. The objective of this study was to describe the efficacy and safety of a pharmacy managed heparin protocol utilizing activated partial thromboplastin time (aPTT) in comparison to our standard physician-managed activated clotting time (ACT)-based anticoagulation in ECMO patients. METHODS: Patients administered a heparin drip while on ECMO were included in the study...
November 10, 2016: Perfusion
https://www.readbyqxmd.com/read/27832552/current-limitations-of-the-assessment-of-haemostasis-in-adult-extracorporeal-membrane-oxygenation-patients-and-the-role-of-point-of-care-testing
#13
K Venkatesh, P S Nair, D J Hoechter, H Buscher
Haemostatic perturbations are commonly seen in extracorporeal membrane oxygenation (ECMO) patients and remain a clinical challenge, contributing significantly to morbidity and mortality. The approach to anticoagulation monitoring and the management of bleeding varies considerably across ECMO centres. Routine laboratory tests have their limitations in terms of turnaround time and specificity of information provided. Newer point-of-care testing (POCT) for coagulation may overcome these issues, as it provides information about the entire coagulation pathway from clot initiation to lysis...
November 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/27811560/advanced-extracorporeal-therapy-in-trauma
#14
David Zonies, Matthias Merkel
PURPOSE OF REVIEW: The purpose is to review the current application of extracorporeal life support (ECLS) in trauma patients. In addition, programmatic development is described. RECENT FINDINGS: ECLS use is increasing among trauma patients. Several recent studies among trauma patients report survival rates of 65-79%. Despite the high bleeding risk, extracorporeal membrane oxygenation (ECMO) may be safely implemented in trauma patients based on a strict protocol-driven policy...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27779577/extracorporeal-membrane-oxygenation-for-adult-respiratory-distress-syndrome-in-trauma-patients-a-case-series-and-systematic-literature-review
#15
Chiara Robba, Andrea Ortu, Federico Bilotta, Alessandra Lombardo, Mypinder S Sekhon, Fabio Gallo, Basil F Matta
BACKGROUND: Venovenous extracorporeal membrane oxygenation (vv-ECMO) is an established salvage therapy for severe respiratory failure, and may provide an alternative form of treatment for trauma-induced adult respiratory distress syndrome (ARDS) when conventional treatments have failed. The need for systemic anticoagulation is a relative contraindication for patients with bleeding risks, especially in multitraumatic injury. METHODS: We describe a case series of four trauma patients with ARDS who were managed with ECMO admitted to the neuro critical care unit at Addenbrooke's Hospital, Cambridge (UK), from January 2000 to January 2016...
January 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27749813/craniectomy-and-traumatic-brain-injury-in-children-on-extracorporeal-membrane-oxygenation-support-case-report-and-review-of-the-literature
#16
Pilar Anton-Martin, Bruno Braga, Stephen Megison, Janna Journeycake, Jessica Moreland
Severe trauma may cause refractory life-threatening respiratory failure requiring extracorporeal membrane oxygenation (ECMO). Concurrent traumatic brain injury, however, complicates the use of ECMO because of the major risk of intracranial bleeding with systemic anticoagulation. Craniotomy and/or craniectomy for hematoma evacuation during ECMO are extremely high-risk procedures secondary to ongoing anticoagulation, and there are only a few such case reports in the literature.We present the case of a child with multiple thoracic injuries and life-threatening respiratory failure supported on ECMO...
October 4, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27749569/extracorporeal-membrane-oxygenation-treatment-of-a-h7n9-caused-respiratory-failure-patient-with-mechanical-valves-replacement-history-a-case-report
#17
Linfeng Qian, Junnan Zheng, Hongfei Xu, Liping Shi, Lanjuan Li
BACKGROUND: Patients with respiratory failure caused by H7N9 may benefit from veno-venous, veno-arterial, and veno-veno-arterial extracorporeal membrane oxygenation (ECMO) support. CASE SUMMARY: A 55-year-old male patient was suffering from H7N9-caused acute respiratory distress syndrome (ARDS). He had a mechanical mitral and aortic valve replacement surgery and was using warfarin for anticoagulation. After prolonged mechanical ventilation, oxygen saturation was not improved...
October 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27714705/predictive-factors-of-bleeding-events-in-adults-undergoing-extracorporeal-membrane-oxygenation
#18
Cécile Aubron, Joris DePuydt, François Belon, Michael Bailey, Matthieu Schmidt, Jayne Sheldrake, Deirdre Murphy, Carlos Scheinkestel, D Jamie Cooper, Gilles Capellier, Vincent Pellegrino, David Pilcher, Zoe McQuilten
BACKGROUND: Bleeding is the most frequent complication associated with extracorporeal membrane oxygenation (ECMO) support in critically ill patients. Nonetheless, risk factors for bleeding have been poorly described especially those associated with coagulation anomalies and anticoagulant therapy during ECMO support. The aim of this study is to describe bleeding complications in critically ill patients undergoing ECMO and to identify risk factors for bleeding events. METHODS: We retrospectively analysed ICU charts of adults who received either veno-venous (VV) or veno-arterial (VA) ECMO support in two participating ICUs between 2010 and 2013...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27690525/anticoagulation-practices-during-venovenous-extracorporeal-membrane-oxygenation-for-respiratory-failure-a-systematic-review
#19
Michael C Sklar, Eric Sy, Laurance Lequier, Eddy Fan, Hussein D Kanji
BACKGROUND: The optimal anticoagulation strategy for venovenous extracorporeal membrane oxygenation (VV-ECMO) is not known. OBJECTIVES: To evaluate the safety of anticoagulation strategies and monitoring during VV-ECMO for respiratory failure. DATA SOURCES: We conducted a systematic review to evaluate the association between anticoagulation strategies during VV-ECMO and prespecified outcomes, including major bleeding episodes, thrombotic events, and in-hospital mortality...
December 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27660905/sources-of-circuit-thrombosis-in-pediatric-extracorporeal-membrane-oxygenation
#20
Susan M Hastings, David N Ku, Scott Wagoner, Kevin O Maher, Shriprasad Deshpande
Extracorporeal membrane oxygenation (ECMO) for cardiopulmonary support of critically ill patients is used frequently in the pediatric population. ECMO is burdened by complications, including thrombosis and hemorrhage. Here we demonstrate the focused location of clots, their histologic composition, and the relationship of in situ thrombus to local hemodynamics in ECMO circuits. Pediatric ECMO circuits from Children's Healthcare of Atlanta, Emory University (Atlanta, GA) were obtained after removal from extracorporeal support over a 2...
January 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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