Characterization of Extracorporeal Membrane Oxygenation Support for Single Ventricle Patients

2020 ◽  
Vol 11 (2) ◽  
pp. 183-191
Author(s):  
Elizabeth H. Stephens ◽  
Aqsa Shakoor ◽  
Shimon E. Jacobs ◽  
Shunpei Okochi ◽  
Ariela L. Zenilman ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Single Ventricle ◽  
Early Recognition ◽  
Orthotopic Heart Transplantation ◽  
Factors Associated ◽  
Membrane Oxygenation ◽  
End Point ◽  
Thrombotic Complications ◽  
Central Cannulation

Background: Extracorporeal membrane oxygenation (ECMO) can provide crucial support for single ventricle (SV) patients at various stages of palliation. However, characterization of the utilization and outcomes of ECMO in these unique patients remains incompletely studied. Methods: We performed a single-center retrospective review of SV patients between 2010 and 2017 who underwent ECMO cannulation with primary end point of survival to discharge and secondary end point of survival to decannulation or orthotopic heart transplantation (OHT). Multivariate analysis was performed for factors predictive of survival to discharge and survival to decannulation. Results: Forty SV patients with a median age of one month (range: 3 days to 15 years) received ECMO support. The incidence of ECMO was 14% for stage I, 3% for stage II, and 4% for stage III. Twenty-seven (68%) patients survived to decannulation, and 21 (53%) patients survived to discharge, with seven survivors to discharge undergoing OHT. Complications included infection (40%), bleeding (40%), thrombosis (33%), and radiographic stroke (45%). Factors associated with survival to decannulation included pre-ECMO lactate (hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.41-0.90, P = .013) and post-ECMO bicarbonate (HR: 1.24, 95% CI: 1.0-1.5, P = .018). Factors associated with survival to discharge included central cannulation (HR: 40.0, 95% CI: 3.1-500.0, P = .005) and lack of thrombotic complications (HR: 28.7, 95% CI: 2.1-382.9, P = .011). Conclusions: Extracorporeal membrane oxygenation can be useful to rescue SV patients with approximately half surviving to discharge, although complications are frequent. Early recognition of the role of heart transplant is imperative. Further study is required to identify areas for improvement in this population.

Venogram before long-interval repeat cannulation for pediatric extracorporeal membrane oxygenation

Perfusion ◽  
2020 ◽  
pp. 026765912092535
Author(s):  
Benjamin D Carr ◽  
Joseph Kohne ◽  
Matthew W Ralls ◽  
Peter Sassalos ◽  
Richard G Ohye ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Male Patient ◽  
Jugular Vein ◽  
Membrane Oxygenation ◽  
Vein Occlusion ◽  
Central Cannulation ◽  
To Receive ◽  
Safe Access ◽  
Multiple Episodes

It is rare for children to receive more than one course of support with extracorporeal membrane oxygenation, and in those who do undergo multiple episodes, the interval is usually days to weeks between events. Little data exists on re-cannulation years after an initial extracorporeal membrane oxygenation run, and late repeat cannulation can pose unique challenges. We report the case of a 10-year-old male patient with right jugular vein occlusion due to a previous course of extracorporeal membrane oxygenation as a neonate, who was successfully supported via central cannulation. This case demonstrates the importance of adequate imaging of target vasculature prior to attempting re-cannulation of a previously used vessel. Establishing a thoughtful strategy for late repeat cannulation is essential to achieve safe access in unusual and challenging situations.

scholarly journals Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)—Comparison of VA- versus VV ECMO

PLoS ONE ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. e0227793 ◽  
Author(s):  
Hannah Appelt ◽  
Alois Philipp ◽  
Thomas Mueller ◽  
Maik Foltan ◽  
Matthias Lubnow ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Factors Associated ◽  
Membrane Oxygenation ◽  
Vv Ecmo

scholarly journals Venoarterial extracorporeal membrane oxygenation use in staged combined heart–kidney transplant

2020 ◽  
Vol 2020 (1) ◽  
Author(s):  
Tareq Al Saadi ◽  
Christopher Sciamanna ◽  
Ambar Andrade ◽  
Sunil Pauwaa ◽  
Gregory Macaluso ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Extracorporeal Membrane Oxygenation ◽  
Heart Transplantation ◽  
Kidney Transplant ◽  
Solid Organ Transplantation ◽  
Orthotopic Heart Transplantation ◽  
Solid Organ ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Va Ecmo

Abstract Outside of heart and lung transplantation, only few cases have been reported describing venoarterial extracorporeal membrane oxygenation (VA-ECMO) use in solid organ transplantation. We present a case of a staged combined heart–kidney transplant in which VA-ECMO was utilized after a complicated orthotopic heart transplantation to successfully complete the subsequent renal transplantation.

Coagulation Profile of Children on Extracorporeal Membrane Oxygenation (ECMO) - Is FXIII the Missing Link?

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3795-3795
Author(s):  
Thorsten Haas ◽  
Carsten Doell ◽  
Markus Schmugge ◽  
Melissa M. Cushing ◽  
Vincenzo Cannizzaro
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Factor Xiii ◽  
Massive Transfusion ◽  
Complete Blood Count ◽  
Published Data ◽  
Reference Ranges ◽  
Bleeding Management ◽  
Membrane Oxygenation ◽  
Thrombotic Complications ◽  
The Impact

Abstract Background Published data about bleeding management on extracorporeal membrane oxygenation (ECMO) in children is sparse and to date no global transfusion algorithm has been established. Viscoelastic testing can be effective for determining the etiology and management of coagulopathic bleeding during cardiothoracic procedures, but data regarding its usefulness in ECMO patients are scarce. Recently, low factor XIII levels were determined to be a frequent finding in adult ECMO patients(Kalbhenn et al; Perfusion 2015;30:675-82). Methods This is a retrospective analysis of thromboelastometry (ROTEM®) and factor XIII data obtained in children (ages 0 to 18 years) undergoing ECMO since 2013 in a single center children's hospital. Acute bleeding treatment was based on daily ROTEM testing, complete blood count and routine plasmatic coagulation testing. The transfusion algorithm targeted a hemoglobin level >13g dL-1, a Quick's value >50%, a plasma fibrinogen level >1.5g L-1, and a platelet count of >100,000 µL-1. Red blood cells (RBC), solvent detergent (S/D) plasma and platelet apheresis concentrates were exclusively used to maintain hemostasis. Measurement of FXIII levels is not part of routine testing, but was assessed when unexplained bleeding was observed. Results Laboratory and transfusion data from sixteen patients, age 4 (1-15) months [median(IQR)] with a body weight of 6 (3-8) kg were included. Median time on ECMO was 7 (4-9) days. Large volumes of allogeneic blood were transfused to all children, meeting criteria for massive transfusion each individual day on ECMO (Tab.1). Overall, median daily ROTEM measurements were within reference ranges (Tab.2), while median levels of FXIII were decreased despite massive transfusion [FXIII levels 42% (28-51%)]. Conclusion Pediatric ECMO was almost always combined with daily massive transfusion, which led to correction of overall ROTEM values. Notably, despite transfusion of large amounts of plasma, decreased FXIII levels were noted. This finding is supported by results of a study in adult ECMO patients, where FXIII levels <50% were observed in 88% of all patients. Although inherited homozygous FXIII deficiency is usually defined by levels <5%, even mildly to moderately reduced FXIII levels have been reported to contribute to increased bleeding after cardiac surgery(Ternström et al; Thromb Res 2010;126:e128-33). Further studies should be performed to assess the impact of FXIII substitution in pediatric ECMO patients and to investigate whether substitution of FXIII may decrease bleeding without increasing thrombotic complications. Disclosures Haas: CSL Behring: Speakers Bureau; TEM International: Speakers Bureau; Octapharma: Consultancy.

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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