Antithrombin III Deficiency in Patients Requiring Extracorporeal Membrane Oxygenation (ECMO) Support

CHEST Journal ◽  
2013 ◽  
Vol 144 (4) ◽  
pp. 319A
Author(s):  
Jonathan Sarik ◽  
Shinya Unai ◽  
Harrison Pitcher ◽  
Qiong Yang ◽  
Hitoshi Hirose ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Antithrombin Iii ◽  
Ecmo Support ◽  
Membrane Oxygenation ◽  
Antithrombin Iii Deficiency

Exogenous supplementation of antithrombin III in adult and pediatric patients receiving extracorporeal membrane oxygenation

2019 ◽  
Vol 43 (5) ◽  
pp. 315-322 ◽  
Author(s):  
Mark N Sorial ◽  
Rebecca A Greene ◽  
Andrew R Zullo ◽  
Christine Berard-Collins ◽  
Steve Willis
Keyword(s):  
Standard Deviation ◽  
Extracorporeal Membrane Oxygenation ◽  
Antithrombin Iii ◽  
P Value ◽  
Heparin Infusion ◽  
Membrane Oxygenation ◽  
Heparin Resistance ◽  
Heparin Anticoagulation ◽  
Antithrombin Iii Deficiency ◽  
Antithrombin Iii Activity

Background: Antithrombin III deficiency can occur with heparin anticoagulation during extracorporeal membrane oxygenation leading to heparin resistance. Antithrombin III supplementation has been shown to improve anticoagulation; however, there is no consensus on appropriate administration. We described the effect of antithrombin III supplementation on coagulation parameters in adult and pediatric extracorporeal membrane oxygenation patients. Methods: We conducted a retrospective cohort study using electronic medical records of patients who received ⩾1 dose of antithrombin III during extracorporeal membrane oxygenation while on continuous heparin. Endpoints included the change in anti-Xa levels and antithrombin III activity at −6 versus 6 h relative to antithrombin III supplementation, and heparin infusion rates at 6 versus 12 h after antithrombin III supplementation. Results: Eighteen patients receiving 36 antithrombin III administrations were analyzed. Mean (standard deviation) anti-Xa values at −6 versus 6 h were 0.15 (0.07) versus 0.24 (0.15) IU/mL ( p-value: 0.250) for pediatrics and 0.19 (0.22) versus 0.31 (0.27) IU/mL ( p-value: 0.052) for adults. Mean (standard deviation) plasma antithrombin III activity at the same intervals were 32% (14.2%) versus 66.8% (25.1%; p-value: 0.062) for pediatrics and 30.3% (14%) versus 52.8% (8.1%; p-value: 0.094) for adults. Mean (standard deviation) heparin rates at 6 versus 12 h after antithrombin III for pediatrics were 23.6 (6) versus 23.5 (6.5) units/kg/h ( p-value: 0.728), and 15.3 (6.6) versus 13.5 (8) units/kg/h ( p-value: 0.188) for adults. Conclusion: Administration of antithrombin III improved anti-Xa levels in both populations, however, did not significantly reduce heparin rates. Our findings suggest that the use of antithrombin III restores heparin responsiveness in patients with low antithrombin III activity and low anti-Xa activity.

The effects of propofol on extracorporeal membrane oxygenation oxygenator exchange

2021 ◽  
pp. 039139882110160
Author(s):  
Kelsey L Browder ◽  
Ayesha Ather ◽  
Komal A Pandya
Keyword(s):  
Cohort Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Cumulative Dose ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Ecmo Support ◽  
Single Center ◽  
Membrane Oxygenation ◽  
Vv Ecmo

The objective of this study was to determine if propofol administration to veno-venous (VV) extracorporeal membrane oxygenation (ECMO) patients was associated with more incidents of oxygenator failure when compared to patients who did not receive propofol. This was a single center, retrospective cohort study. The primary outcome of the study is oxygenator exchanges per ECMO day in patients who received propofol versus those who did not receive propofol. Patients were 18 years or older on VV-ECMO support between January 1, 2015 and January 31, 2018. Patients were excluded if they required ECMO support for less than 48 h or greater than 21 days. There were five patients in the propofol arm that required oxygenator exchanges and seven patients in the control arm. The total number of oxygenator exchanges per ECMO day was not significantly different between groups ( p = 0.50). When comparing those who required an oxygenator exchange and those who did not, there was no difference in the cumulative dose of propofol received per ECMO hour (0.64 mg/kg/h vs 0.96 mg/kg/h; p = 0.16). Propofol use in patients on VV-ECMO does not appear to increase the number of oxygenator exchanges.

Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support

Perfusion ◽  
2021 ◽  
pp. 026765912110128
Author(s):  
Ismael A Salas De Armas ◽  
Bindu Akkanti ◽  
Pratik B Doshi ◽  
Manish Patel ◽  
Sachin Kumar ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Injury Severity ◽  
Invasive Mechanical Ventilation ◽  
Ecmo Support ◽  
Trauma Patients ◽  
Membrane Oxygenation ◽  
Trauma Service ◽  
Proper Patient Selection ◽  
Vv Ecmo

Background: Respiratory failure (RF) is a common cause of death and morbid complication in trauma patients. Extracorporeal membrane oxygenation (ECMO) is increasingly used in adults with RF refractory to invasive mechanical ventilation. However, use of ECMO remains limited for this patient population as they often have contraindications for anticoagulation. Study design: Medical records were retroactively searched for all adult patients who were admitted to the trauma service and received veno-venous ECMO (VV ECMO) support between June 2015 and August 2018. Survival to discharge and ECMO-related complications were collected and analyzed. Results: Fifteen patients from a large Level I trauma center met the criteria. The median PaO2/FiO2 ratio was 53.0 (IQR, 27.0–76.0), median injury severity score was 34.0 (IQR, 27.0–43.0), and the median duration of ECMO support was 11 days (IQR, 7.5–20.0). For this cohort, the survival-to-discharge rate was 87% (13/15). The incidence of neurologic complications was 13%, and deep vein thrombosis was reported in two cases (13%). Conclusions: Survival rates of trauma patients in this study are equivalent to, or may exceed, those of non-trauma patients who receive ECMO support for other types of RF. With the employment of a multidisciplinary team assessment and proper patient selection, early cannulation, traumatic RF may be safely supported with VV ECMO in experienced centers.

scholarly journals Extracorporeal membrane oxygenation (ECMO) for COVID-19 patients

2021 ◽  
Author(s):  
Surat Tongyoo ◽  
Suneerat Kongsayreepong
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Ecmo Support ◽  
Janus Kinase ◽  
Systemic Steroid ◽  
Heparin Infusion ◽  
Membrane Oxygenation ◽  
Rescue Treatment ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Individual

During the current outbreak of coronavirus disease 2019 (COVID-19), Extracorporeal Membrane Oxygenation (ECMO) support could be considered as the rescue treatment from life threatening condition among severe COVID-19 patients who did not respond to mechanical ventilation. We propose that veno-venous ECMO should be considered if patient has persistence PaO2:FiO2 ratio lower than 100 mmHg after appropriate mechanical ventilator adjustment, muscle relaxant and prone position. During ECMO support, treatment against cytokine storm, including non-selective immune suppression with systemic steroid, or selective interleukin-6 inhibition and Janus Kinase inhibition should be considered. Heparin infusion is still the recommended anticoagulant to maintain activated partial thromboplastin time (APTT) ratio range 1.5-2.0. The overall hospital mortality was comparable with respiratory failure patients, requiring ECMO support from other causes, which was reported about 37-50%. The decision to initiate ECMO could be depended on the individual hospital capacity and treatment availability.

scholarly journals Bronchotracheal Stenting Management by Rigid Bronchoscopy under Extracorporeal Membrane Oxygenation (ECMO) Support: 10 Years of Experience in a Tertiary Center

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Sabrina Meyer ◽  
Anne-Sophie Dincq ◽  
Lionel Pirard ◽  
Sebahat Ocak ◽  
Jean-Paul D’Odémont ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Rigid Bronchoscopy ◽  
Ecmo Support ◽  
Membrane Oxygenation ◽  
Tertiary Center ◽  
Airway Stenting ◽  
Life Threatening ◽  
Venovenous Ecmo ◽  
Central Airway

Purpose. Airway stenting offers good palliation and improves the quality of life in patients with inoperable bronchotracheal stenosis. However, in some cases, the management of stenting can be life-threatening. Hence, a strategy for maintaining oxygenation and hemodynamic stability should be anticipated to avoid critical situations. Herein, we report the use of extracorporeal membrane oxygenation (ECMO) in bronchotracheal stenting management to secure oxygenation and facilitate interventions. Methods. We retrospectively reviewed all patients who underwent rigid bronchoscopy under ECMO support for the management of bronchotracheal stenting at CHU UCL Namur hospital (Belgium), between January 2009 and December 2019. Results. We included 14 bronchoscopy cases performed on 11 patients (3 patients underwent 2 bronchoscopies) in this study; 12 were performed on males and 2 on females. The median age was 54 years. There were 11 benign and 3 malignant etiologies for the central airway obstruction/stenosis. Eight cases were supported by venovenous ECMO and six by venoarterial ECMO. The median ECMO time was 267 minutes. The weaning of ECMO support was successful in all cases. In most cases, the procedures were performed effectively and safely. Only two local complications caused by the cannulation of ECMO were reported, and anticoagulation was adapted to avoid bleeding at the operating site and clot formation in the system. Conclusion. Elective ECMO support was helpful and safe for the high-risk management of bronchotracheal stenting with rigid bronchoscopy and was not associated with any additional significant complications.

Impact of extracorporeal membrane oxygenation (ECMO) support on piperacillin exposure in septic patients: a case–control study

2021 ◽  
Author(s):  
P Fillâtre ◽  
F Lemaitre ◽  
N Nesseler ◽  
M Schmidt ◽  
S Besset ◽  
...  
Keyword(s):  
Steady State ◽  
Extracorporeal Membrane Oxygenation ◽  
Creatinine Clearance ◽  
Sofa Score ◽  
Case Control Study ◽  
Case Control ◽  
Ecmo Support ◽  
Icu Patients ◽  
Membrane Oxygenation ◽  
Control Study

Abstract Objectives To describe the impact of extracorporeal membrane oxygenation (ECMO) devices on piperacillin exposure in ICU patients. Methods This observational, prospective, multicentre, case–control study was performed in the ICUs of two tertiary care hospitals in France. ECMO patients with sepsis treated with piperacillin/tazobactam were enrolled. Control patients were matched according to SOFA score and creatinine clearance. The pharmacokinetics of piperacillin were described based on a population pharmacokinetic model, calculating the proportion of time the piperacillin plasma concentration was above 64 mg/L (i.e. 4× MIC breakpoint for Pseudomonas aeruginosa). Results Forty-two patients were included. Median (IQR) age was 60 years (49–66), SOFA score was 11 (9–14) and creatinine clearance was 47 mL/min (5–95). There was no significant difference in the proportion of time piperacillin concentrations were ≥64 mg/L in patients treated with ECMO and controls during the first administration (P = 0.184) or at steady state (P = 0.309). Following the first administration, 36/42 (86%) patients had trough piperacillin concentrations <64 mg/L. Trough concentrations at steady state were similar in patients with ECMO and controls (P = 0.535). Creatinine clearance ≥40 mL/min was independently associated with piperacillin trough concentration <64 mg/L at steady state [OR = 4.3 (95% CI 1.1–17.7), P = 0.043], while ECMO support was not [OR = 0.5 (95% CI 0.1–2.1), P = 0.378]. Conclusions ECMO support has no impact on piperacillin exposure. ICU patients with sepsis are frequently underexposed to piperacillin, which suggests that therapeutic drug monitoring should be strongly recommended for severe infections.

scholarly journals COVID-19 Pulmonary Failure and Extracorporeal Membrane Oxygenation: First Experience from Three European Extracorporeal Membrane Oxygenation Centers

2020 ◽  
Author(s):  
Charles Abraham Yankah ◽  
Richard Trimlett ◽  
Elena Sandoval ◽  
Christopher Lotz ◽  
Stephane Ledot ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Multiorgan Failure ◽  
Advanced Life Support ◽  
Ecmo Support ◽  
Female Ratio ◽  
Membrane Oxygenation ◽  
The United Kingdom ◽  
International Experts ◽  
Vv Ecmo

AbstractOn April 17, 2020, a coronavirus disease 2019 (COVID-19) webinar was held by selected international experts in the field of intensive care and specialized respiratory ECMO centers from Germany, Italy, Spain, and the United Kingdom, which was hosted by the German Heart Centre Berlin/Charité. The experts shared their experience about the treatment of 42 patients with severe acute respiratory failure requiring venovenous extracorporeal membrane oxygenation (VV-ECMO). Patients were predominantly male (male-to-female ratio: 3:1), with a mean age of 51 years (range: 25–73 years). VV-ECMO support was indicated in 30% of the ventilated COVID-19 patients. The mean time requiring mechanical ventilation was 16.5 days, with a mean duration of ECMO support of 10.6 days. At the time of the webinar, a total of 17 patients had already been decannulated from ECMO, whereas six died with multiorgan failure. 18 patients remained on ECMO, with their final outcomes unknown at the time of the webinar. Hospital mortality was 25.6% (as of April 17, 2020). In this respect, VV-ECMO, provided by expert centers, is a recognized and validated mode of advanced life-support during the recent COVID-19 pandemic with good outcomes.

scholarly journals Delaying Decannulation After Extracorporeal Membrane Oxygenation Is Safe and Advantageous

2019 ◽  
Vol 10 (1) ◽  
pp. 98-100 ◽  
Author(s):  
Jess L. Thompson ◽  
Elaine Griffeth ◽  
Nicholas Rappa ◽  
Colette Calame ◽  
Robert W. Letton ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Adverse Outcomes ◽  
Ecmo Support ◽  
Time Interval ◽  
Single Patient ◽  
Children's Hospital ◽  
Membrane Oxygenation ◽  
The Mean ◽  
Systemic Anticoagulation ◽  
Ecmo Therapy

Removal of extracorporeal membrane oxygenation (ECMO) cannulae and discontinuing systemic anticoagulation typically occurs soon after separation from ECMO. We have found, however, that delaying decannulation after terminating ECMO therapy does not predispose to adverse outcomes and may be advantageous. Between January 2014 and June 2016, 36 postcardiotomy patients at the Children’s Hospital of Oklahoma required ECMO. In this cohort of 36 patients, there was a need for 42 ECMO runs. Of the 42 ECMO runs, 29 (69%) survived to decannulation. Of those ECMO runs that survived to decannulation, 18 (62%) were cannulated centrally and 11 (38%) were cannulated via the neck. For the runs where the patient survived to decannulation, the mean number of days on ECMO support was 4 ± 2 days. There was an average time interval of 21 ± 14 hours from ECMO termination to decannulation. A single patient failed being separated from ECMO support and required reinstitution of ECMO 18 hours after separation (but did not require recannulation).

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