scholarly journals Disseminated Multifocal Intracerebral Bleeding Events in Three Coronavirus Disease 2019 Patients on Extracorporeal Membrane Oxygenation As Rescue Therapy

2020 ◽  
Vol 2 (9) ◽  
pp. e0218
Author(s):  
Karl Bihlmaier ◽  
Roland Coras ◽  
Carsten Willam ◽  
Steffen Grampp ◽  
Samir Jabari ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Rescue Therapy ◽  
Bleeding Events ◽  
Intracerebral Bleeding ◽  
Membrane Oxygenation

scholarly journals Anticoagulation after VA-ECMO decannulation, providing new insights

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
A Maestro-Benedicto ◽  
A Duran-Cambra ◽  
M Vila-Perales ◽  
J Sans-Rosello ◽  
J Carreras-Mora ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Anticoagulation Therapy ◽  
Thromboembolic Events ◽  
Bleeding Events ◽  
Membrane Oxygenation ◽  
Funding Sources ◽  
Va Ecmo ◽  
A Prospective Study

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an essential tool for the management of refractory cardiogenic shock. Little is known about the incidence of thromboembolic events after V-A ECMO decannulation, although some studies report a high incidence of cannula-related venous thrombosis after venovenous extracorporeal membrane oxygenation (VV-ECMO). Due to this fact, in our institution anticoagulation therapy is systematically prescribed for at least 3 months after VA-ECMO per protocol.  AIM The main objective of this study was to explore the feasibility of 3-month anticoagulation therapy after VA-ECMO decannulation. METHODS We performed a prospective study that included 27 consecutive patients who were successfully treated with VA-ECMO in a medical ICU between 2016 and 2019 and were prescribed 3-month anticoagulation therapy per protocol after decannulation. Exclusion criteria was dying on ECMO or while on the ICU. Data analysis included demographics, mean days on ECMO, 3-month survival, and thromboembolic and bleeding events (excluding immediate post-decannulation bleeding, since anticoagulation was prescribed 24h after). RESULTS Our cohort consisted mainly of men (N = 21, 78%), with a mean age of 60 ± 11 years and a mean time on VA-ECMO of 8 ± 3 days, who primarily suffered from post-cardiotomy cardiogenic shock (N = 9, 34%) or acute myocardial infarction (N = 6, 23%). 5 patients (18%) received a heart transplant. Regarding anticoagulation, 15 patients (60%) had other indications apart from the protocol, like incidental thrombus diagnosis (N = 7, 26%) or valve surgery (N = 5, 18%). Anticoagulation therapy was not feasible in 1 patient (4%) with severe thrombopenia. No patients had severe or life-threatening bleeding events in the follow-up, although 8 patients (30%) had bleeding events, mainly gastrointestinal bleeding (N = 4, 15%), requiring withdrawal of anticoagulation in 1 patient. The incidence of thromboembolic events was 7%; two patients with low-risk pulmonary embolisms. During the 3-month follow-up survival rate was 95%. CONCLUSIONS This is the only study to date addressing the strategy of 3-month anticoagulation therapy after VAECMO, showing it is feasible and safe and may be helpful in reducing or ameliorate thromboembolic complications in the follow-up, although it is not exempt of complications. Abstract Figure. Kaplan-Meier survival analysis

Inhaled Nitric Oxide Trials: "Vive la différence!"

PEDIATRICS ◽  
1996 ◽  
Vol 97 (3) ◽  
pp. 438-438
Author(s):  
DENNIS DAVIDSON
Keyword(s):  
Nitric Oxide ◽  
Clinical Trials ◽  
Pulmonary Hypertension ◽  
Optimal Design ◽  
Extracorporeal Membrane Oxygenation ◽  
Rescue Therapy ◽  
Underlying Disease ◽  
Inhaled Nitric Oxide ◽  
Persistent Pulmonary Hypertension ◽  
Membrane Oxygenation

The commentary by Drs Abman and Kinsella entitled "Inhaled Nitric Oxide for Persistent Pulmonary Hypertension of the Newborn: The Physiology Matters!" provides one important and valid viewpoint concerning the optimal design of clinical trials in this area of neonatology. The approach that they advocate involves individualized and meticulous care of persistent pulmonary hypertension of the newborn (PPHN) patients depending on their underlying disease, using whatever conventional or rescue therapy (before extracorporeal membrane oxygenation [ECMO] is needed to support the patient, while testing the efficacy of inhaled nitric oxide (I-NO).

scholarly journals Extracorporeal membrane oxygenation as rescue therapy for severe hypoxemic respiratory failure

2019 ◽  
Vol 11 (S14) ◽  
pp. S1688-S1697 ◽  
Author(s):  
Bhoumesh Patel ◽  
Subhasis Chatterjee ◽  
Seanna Davignon ◽  
J. Patrick Herlihy
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Rescue Therapy ◽  
Hypoxemic Respiratory Failure ◽  
Membrane Oxygenation

Cost-effectiveness of Argatroban Versus Heparin Anticoagulation in Adult Extracorporeal Membrane Oxygenation Patients

2019 ◽  
pp. 001857871989009
Author(s):  
Angelina E. Cho ◽  
Kathleen Jerguson ◽  
Joy Peterson ◽  
Deepa V. Patel ◽  
Asif A. Saberi
Keyword(s):  
Cost Effectiveness ◽  
Extracorporeal Membrane Oxygenation ◽  
Average Cost ◽  
P Value ◽  
Bleeding Events ◽  
Membrane Oxygenation ◽  
Increased Risk ◽  
Heparin Anticoagulation ◽  
Ischemic Events ◽  
Ecmo Therapy

Purpose: The purpose of this study was to evaluate the cost effectiveness of argatroban compared to heparin during extracorporeal membrane oxygenation (ECMO) therapy. Methods: This was a retrospective study of patients who received argatroban or heparin infusions with ECMO therapy at a community hospital between January 1, 2017 and June 30, 2018. Adult patients who received heparin or argatroban for at least 48 hours while on venovenous (VV) or venoarterial (VA) ECMO were included. Patients with temporary mechanical circulatory assist devices were excluded. Each continuous course of anticoagulant exposure that met the inclusion criteria was evaluated. The primary endpoint was the total cost of anticoagulant therapy for heparin versus argatroban, including all administered study drugs, blood or factor products, and associated laboratory tests. Secondary endpoints included safety and efficacy of anticoagulation with each agent during ECMO. Documentation of bleeding events, circuit clotting, and ischemic events were noted. Partial thromboplastin time (PTT) values were evaluated for time to therapeutic range and percentage of therapeutic PTTs. Results: A total of 11 courses of argatroban and 24 courses of heparin anticoagulation were included in the study. The average cost per course of argatroban was less than the average cost per course of heparin ($7,091.98 vs $15,323.49, respectively; P value = 0.15). Furthermore, argatroban was not associated with an increased incidence of bleeding, thrombotic, or ischemic events. Conclusion: Argatroban may be more cost-effective during ECMO therapy in patients with low antithrombin III levels without increased risk of adverse events.

Evaluation of a pharmacy managed heparin protocol for extracorporeal membrane oxygenation patients

Perfusion ◽  
2016 ◽  
Vol 32 (3) ◽  
pp. 238-244 ◽  
Author(s):  
Kalliopi Fitousis ◽  
Robin Klasek ◽  
Phillip E Mason ◽  
Faisal Masud
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Study Groups ◽  
Similar Rate ◽  
Bleeding Events ◽  
Membrane Oxygenation ◽  
Activated Clotting Time ◽  
Primary Endpoints ◽  
Significant Difference ◽  
Heparin Anticoagulation ◽  
Thrombotic Complications

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. The primary endpoints were the incidence of hemorrhagic and thrombotic complications. Results: A total of 122 adult patients were identified who were on ECMO with heparin anticoagulation; sixty-one patients were managed with each of the physician-managed ACT and pharmacy managed aPTT protocols. No statistically significant difference was observed between the physician ACT and the pharmacy aPTT groups in overall hemorrhagic (69% vs 80%, p=0.145) or thrombotic complications (41% vs 39%, p=0.853). Conclusion: There was a similar rate of thrombotic and bleeding events between the two study groups. A pharmacy managed heparin protocol utilizing aPTT monitoring appears to be a safe and effective method of providing anticoagulation in adult ECMO patients.

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