scholarly journals Oseltamivir improved thrombocytopenia during veno-arterial extracorporeal membrane oxygenation in adults with refractory cardiac failure: A single-center retrospective real-world study

2021 ◽  
Author(s):  
Yuan Li ◽  
Lin Wang ◽  
Jianning Zhang ◽  
Hui Han ◽  
Han Liu ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Real World ◽  
Severe Thrombocytopenia ◽  
Single Center ◽  
Platelet Counts ◽  
Membrane Oxygenation ◽  
Failure Assessment ◽  
Va Ecmo ◽  
Cox Analysis ◽  
Platelet Count Nadir

Abstract Background Severe thrombocytopenia is a common complication of extracorporeal membrane oxygenation (ECMO). Oseltamivir can be used to treat infection-associated thrombocytopenia. Objective To evaluate the effect of oseltamivir on attenuating severe thrombocytopenia during ECMO. Methods This was a single-center real-world study in critically ill patients supported with venous-arterial extracorporeal membrane oxygenation (VA-ECMO). Patients suspected or confirmed with influenza received oseltamivir according to the Chinese guidelines. Thrombocytopenia and survival were compared between the oseltamivir-treated and -untreated groups. The factors associated with survival were analyzed by multivariable Cox analysis. Results A total of 82 patients were included. All patients developed thrombocytopenia after initiating VA-ECMO. Twenty-three patients received oseltamivir (O+ group), and 59 did not (O− group). During the first 8 days of VA-ECMO initiation, the platelet counts in the O+ group were higher than in the O− group (all P < 0.05). The patients in the O+ group had higher median platelet counts at the nadir (77,000/µL, 6,000-169,000/µL), compared with the O− group (49,000/µL, 2,000-168,000/µL; P = 0.04). A platelet count nadir < 50,000/µL was seen in 26% of the patients in the O+ group, compared with 53% in the O− group (P = 0.031). No significant differences in survival to discharge were seen between the O+ and O− groups (48% vs. 56%, P = 0.508). Only the Sequential Organ Failure Assessment (SOFA) scores at the time of VA-ECMO initiation were independently associated with survival (OR = 1.12, 95% confidence interval (95% CI): 1.02–1.22, P = 0.015). Conclusions Oseltamivir could ameliorate VA-ECMO-related thrombocytopenia. These findings suggest the prophylactical potential of oseltamivir on severe thrombocytopenia associated with the initiation of VA-ECMO.

scholarly journals Oseltamivir improved thrombocytopenia during veno-arterial extracorporeal membrane oxygenation in adults with refractory cardiac failure: A single-center retrospective real-world study

2021 ◽  
Author(s):  
Yuan Li ◽  
Lin Wang ◽  
Jianning Zhang ◽  
Hui Han ◽  
Han Liu ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Real World ◽  
Severe Thrombocytopenia ◽  
Single Center ◽  
Platelet Counts ◽  
Membrane Oxygenation ◽  
Failure Assessment ◽  
Va Ecmo ◽  
Cox Analysis ◽  
Platelet Count Nadir

Abstract Background Severe thrombocytopenia is a common complication of extracorporeal membrane oxygenation (ECMO). Oseltamivir can be used to treat infection-associated thrombocytopenia. Objective To evaluate the effect of oseltamivir on attenuating severe thrombocytopenia during ECMO. Methods This was a single-center real-world study in critically ill patients supported with venous-arterial extracorporeal membrane oxygenation (VA-ECMO). Patients suspected or confirmed with influenza received oseltamivir according to the Chinese guidelines. Thrombocytopenia and survival were compared between the oseltamivir-treated and -untreated groups. The factors associated with survival were analyzed by multivariable Cox analysis. Results A total of 82 patients were included. All patients developed thrombocytopenia after initiating VA-ECMO. Twenty-three patients received oseltamivir (O+ group), and 59 did not (O− group). During the first 8 days of VA-ECMO initiation, the platelet counts in the O+ group were higher than in the O− group (all P < 0.05). The patients in the O+ group had higher median platelet counts at the nadir (77,000/µL, 6,000-169,000/µL), compared with the O− group (49,000/µL, 2,000-168,000/µL; P = 0.04). A platelet count nadir < 50,000/µL was seen in 26% of the patients in the O+ group, compared with 53% in the O− group (P = 0.031). No significant differences in survival to discharge were seen between the O+ and O− groups (48% vs. 56%, P = 0.508). Only the Sequential Organ Failure Assessment (SOFA) scores at the time of VA-ECMO initiation were independently associated with survival (OR = 1.12, 95% confidence interval (95% CI): 1.02–1.22, P = 0.015). Conclusions Oseltamivir could ameliorate VA-ECMO-related thrombocytopenia. These findings suggest the prophylactical potential of oseltamivir on severe thrombocytopenia associated with the initiation of VA-ECMO.

scholarly journals Oseltamivir Improved Thrombocytopenia During Veno-Arterial Extracorporeal Membrane Oxygenation in Adults With Refractory Cardiac Failure: A Single-Center Retrospective Real-World Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuan Li ◽  
Lin Wang ◽  
Jianning Zhang ◽  
Hui Han ◽  
Han Liu ◽  
...  
Keyword(s):  
Platelet Count ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiac Failure ◽  
Real World ◽  
Severe Thrombocytopenia ◽  
Single Center ◽  
Membrane Oxygenation ◽  
Significant Difference ◽  
Va Ecmo ◽  
Cox Analysis

Background: Severe thrombocytopenia is a common complication of extracorporeal membrane oxygenation (ECMO). Oseltamivir can be used to treat infection-associated thrombocytopenia.Objective: To evaluate the effect of oseltamivir on attenuating severe thrombocytopenia during ECMO.Methods: This was a single-center real-world study in critically ill patients supported with venous-arterial extracorporeal membrane oxygenation (VA-ECMO). Patients suspected or confirmed with influenza received oseltamivir according to the Chinese guidelines. Thrombocytopenia and survival were compared between the oseltamivir-treated and untreated group. The factors associated with survival were analyzed by multivariable Cox analysis.Results: A total of 82 patients were included. All patients developed thrombocytopenia after initiating VA-ECMO. Twenty-three patients received oseltamivir (O+ group), and 59 did not use oseltamivir (O− group). During the first 8 days after VA-ECMO initiation, the platelet count in the O+ group was higher than that in the O− group (all P &lt; 0.05). The patients in the O+ group had a higher median nadir platelet count (77,000/μl, 6,000–169,000/μl) compared with the O− group (49,000/μl, 2,000–168,000/μl; P = 0.04). A nadir platelet count of &lt;50,000/μl was seen in 26% of the patients in the O+ group, compared with 53% in the O− group (P = 0.031). No significant difference in survival from cardiac failure was seen between the O+ and O− group (48 vs. 56%, P = 0.508). The Sequential Organ Failure Assessment (SOFA) score on initiation of VA-ECMO were independently associated with survival (OR = 1.12, 95% confidence interval (95% CI): 1.02–1.22, P = 0.015).Conclusions: Oseltamivir could ameliorate VA-ECMO-related thrombocytopenia. These findings suggested the prophylactic potential of oseltamivir on severe thrombocytopenia associated with the initiation of VA-ECMO.

Abstract 16543: Severe Thrombocytopenia is Common in Adults Undergoing Venoarterial Extracorporeal Membrane Oxygenation and is Predictive of Hemorrhage

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tia C Kohs ◽  
Vikram Raghunathan ◽  
Patricia Liu ◽  
Ramin Amirsoltani ◽  
Michael Oakes ◽  
...  
Keyword(s):  
Overall Survival ◽  
Logistic Regression ◽  
Platelet Count ◽  
Extracorporeal Membrane Oxygenation ◽  
Clinical Implications ◽  
Severe Thrombocytopenia ◽  
Multivariate Logistic Regression ◽  
Membrane Oxygenation ◽  
Increased Risk ◽  
Va Ecmo

Introduction: Extracorporeal membrane oxygenation (ECMO) is used to provide circulatory support and facilitate gas exchange via cardiopulmonary bypass. The relationship between ECMO and the incidence of severe thrombocytopenia (platelet count <50 x 10 9 /L) and subsequent clinical consequences are ill defined. We aimed to identify the risk factors for the development of thrombocytopenia and its clinical implications. Methods: This is a single-center retrospective cohort study of adults who received venoarterial (VA) ECMO. We examined consecutive platelet counts while on ECMO. Univariate logistic regression was used to determine if mean platelet count, platelet count range, or severe thrombocytopenia were predictors of overall survival, hemorrhage and thrombosis. A multivariate logistic regression model was used to identify factors that contribute to the development of the aforementioned patient outcomes. Results: In our cohort, 33 patients were included with a mean age of 55 years and duration of ECMO of 5.9 days. All patients received heparin, 33.3% received antiplatelet therapy and 45.5% developed severe thrombocytopenia. In univariate, analysis the development of severe thrombocytopenia increased the odds of major bleeding by 450% (OR 5.500, 95% CI 1.219 - 24.813, P -value 0.027), and the odds of surviving hospitalization decreased 84.1% (OR 0.159, 95% CI 0.033 - 0.773, P -value 0.023). Multivariate logistic regression controlling for additional clinical variables found no significant association between the development of severe thrombocytopenia and rates of thrombosis, hemorrhage, or overall survival. Platelet count decreased over time while on ECMO. Conclusions: Nearly half of the patients requiring VA-ECMO developed severe thrombocytopenia, which was associated with an increased risk of hemorrhage and in-hospital mortality. Additional studies are required to clarify the clinical implications of severe thrombocytopenia in ECMO patients.

scholarly journals Conversion from Venovenous to Venoarterial Extracorporeal Membrane Oxygenation in Adults

Membranes ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 188
Author(s):  
Lars Falk ◽  
Alexander Fletcher-Sandersjöö ◽  
Jan Hultman ◽  
Lars Mikael Broman
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Right Ventricular Failure ◽  
Survival Prediction ◽  
Ventricular Failure ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Failure Assessment ◽  
Va Ecmo ◽  
Rv Function ◽  
Vv Ecmo

No major study has been performed on the conversion from venovenous (VV) to venoarterial (VA) extracorporeal membrane oxygenation (ECMO) in adults. This single-center retrospective cohort study aimed to investigate the incidence, indication, and outcome in patients who converted from VV to VA ECMO. All adult patients (≥18 years) who commenced VV ECMO at our center between 2005 and 2018 were screened. Of 219 VV ECMO patients, 21% (n = 46) were converted to VA ECMO. The indications for conversion were right ventricular failure (RVF) (65%), cardiogenic shock (26%), and other (9%). In the converted patients, there was a significant increase in Sequential Organ Failure Assessment (SOFA) scores between admission 12 (9–13) and conversion 15 (13–17, p < 0.001). Compared to non-converted patients, converted patients also had a higher mortality rate (62% vs. 16%, p < 0.001) and a lower admission Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score (p < 0.001). Outcomes were especially unfavorable in those converted due to RVF. These results indicate that VA ECMO, as opposed to VV ECMO, should be considered as the first mode of choice in patients with respiratory failure and signs of circulatory impairment, especially in those with impaired RV function. For the remaining patients, Pre-admission RESP score, daily echocardiography, and SOFA score trajectories may help in the early identification of those where conversion from VV to VA ECMO is warranted. Multi-centric studies are warranted to validate these findings.

Bedside angiography of distal perfusion catheter for veno-arterial extracorporeal membrane oxygenation

Perfusion ◽  
2021 ◽  
pp. 026765912110070
Author(s):  
Aakash Shah ◽  
Danielle Arons ◽  
Chetan Pasrija ◽  
Zachary N Kon ◽  
Mehrdad Ghoreishi
Keyword(s):  
Lower Extremity ◽  
Extracorporeal Membrane Oxygenation ◽  
Retrospective Analysis ◽  
Saphenous Vein ◽  
Single Center ◽  
Membrane Oxygenation ◽  
Distal Perfusion ◽  
Va Ecmo

Background: The aim of this study was to evaluate the ipsilateral lower extremity (ILE) outcomes of patients who underwent bedside angiography via the distal perfusion catheter while on femoral veno-arterial extracorporeal membrane oxygenation (VA ECMO). Methods: This is a retrospective analysis of all patients placed on VA ECMO at a single center from January 2017 to December 2019 who underwent bedside angiography via the distal perfusion catheter. Results: Twenty-four patients underwent bedside angiography via the distal perfusion catheter after being placed on VA ECMO. A vasodilator was directly administered in three patients for suspected spasm. One patient had distal thrombus and underwent thrombectomy and fasciotomy. One patient had a dislodged catheter and underwent thrombectomy, fasciotomy, and replacement of the catheter. One patient had severe ILE ischemia, however was not intervened upon due to critical acuity. Finally, one patient had inadvertent placement in the saphenous vein and had a new catheter placed in the SFA. No patients underwent amputation. Ultimately, 21 patients (87.5%) had no ILE compromise at the end their ECMO course. Survival to decannulation was 66.7% ( n = 16). Conclusions: Bedside angiography of the distal perfusion catheter is feasible and can be a useful adjunct in informing the need for further intervention to the ILE. Classifications: extracorporeal membrane oxygenation, ischemia

Single-Center Outcome of Pediatric Extracorporeal Membrane Oxygenation

2013 ◽  
Vol 61 (S 02) ◽  
Author(s):  
A Rüffer ◽  
F Münch ◽  
A Purbojo ◽  
O Toka ◽  
M Glöckler ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Single Center ◽  
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

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