scholarly journals Control of Coagulation during Extracorporeal Membrane Oxygenation

2005 ◽  
Vol 10 (1) ◽  
pp. 26-35
Author(s):  
Marcia L. Buck
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Aminocaproic Acid ◽  
Endothelial Damage ◽  
Alternative Therapies ◽  
Factor Vii ◽  
Heparin Induced Thrombocytopenia ◽  
Prevention Of Thrombosis ◽  
Delicate Balance ◽  
Membrane Oxygenation

The use of extracorporeal membrane oxygenation (ECMO) requires maintaining a delicate balance between the prevention of thrombosis and the avoidance of hemorrhage. Anticoagulation is necessary to maintain circuit flow. It counteracts the activation of clotting mechanisms that occurs as a result of the interaction between circulating blood and the foreign surfaces of the ECMO equipment as well as endothelial damage within the vasculature. Heparin remains the anticoagulant of choice; however, the difficulty in adjusting dosages and the risk of developing heparin-induced thrombocytopenia have led to the use of alternative therapies such as argatroban and lepirudin. In addition, thrombolysis with alteplase is now being used in patients who develop clots despite anticoagulation. Aminocaproic acid has been used for more than a decade to manage or prevent hemorrhage in patients on ECMO, but a new report suggests that activated recombinant factor VII may also be useful as a hemostatic agent. Over the next decade, it is likely that the role of these newer agents will grow, making them important tools in the management of patients on ECMO.

scholarly journals Heparin-induced thrombocytopenia in patients on extracorporeal membrane oxygenation and the role of a heparin-bonded circuit

Perfusion ◽  
2019 ◽  
Vol 34 (7) ◽  
pp. 584-589 ◽  
Author(s):  
Dirk Pabst ◽  
Jacqueline B Boone ◽  
Behzad Soleimani ◽  
Christoph E Brehm
Keyword(s):  
Overall Survival ◽  
Platelet Count ◽  
Retrospective Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Serotonin Release ◽  
Single Center ◽  
Heparin Induced Thrombocytopenia ◽  
Membrane Oxygenation ◽  
Release Assay

Background: In patients supported with extracorporeal membrane oxygenation, and who develop heparin-induced thrombocytopenia, there is no clear evidence to support changing to a non-heparin-coated extracorporeal membrane oxygenation circuit. Our goal was to evaluate clinical outcomes of patients who were continued on heparin-bonded circuits despite diagnosed heparin-induced thrombocytopenia. Methods: We completed a single-center retrospective study of all patients who underwent extracorporeal membrane oxygenation support from July 2008 to July 2017 and were tested heparin-induced thrombocytopenia positive while on extracorporeal membrane oxygenation support. After diagnosis of heparin-induced thrombocytopenia, mean platelet count (k/µL) was measured on consecutive days for 14 days. Results: Out of 455 patients, 14 (3.1%) had a diagnosis of heparin-induced thrombocytopenia by serotonin release assay and systemic heparin treatment was discontinued in every case. In total, 11 of the heparin-induced thrombocytopenia patients (78.6%) survived to discharge. The overall survival of all 455 extracorporeal membrane oxygenation patients was 54.1%. Platelets counts after discontinuation of systemic heparin in the heparin-induced thrombocytopenia patients increased from a mean of 59.8 k/µL at time of heparin-induced thrombocytopenia diagnosis to a mean of 280.2 k/µL at 14 days after discontinuation of heparin despite continuation of the heparin-bonded circuit. Platelet count increased in heparin-induced thrombocytopenia patients on extracorporeal membrane oxygenation support after discontinuation of systemic heparin even if maintained on the heparin-bonded circuit. Conclusion: Discontinuation of systemic heparin but continuation of heparin-coated extracorporeal membrane oxygenation circuits appeared to be an appropriate response for our extracorporeal membrane oxygenation–supported patients who developed heparin-induced thrombocytopenia. Survival in this group was not significantly different to those patients on extracorporeal membrane oxygenation without heparin-induced thrombocytopenia. Larger studies should evaluate the safety of heparin-bonded extracorporeal membrane oxygenation systems in heparin-induced thrombocytopenia patients.

scholarly journals Activated recombinant factor VII for refractory bleeding during extracorporeal membrane oxygenation

2004 ◽  
Vol 127 (6) ◽  
pp. 1812-1813 ◽  
Author(s):  
Ann Verrijckt ◽  
François Proulx ◽  
Sylvain Morneau ◽  
Suzanne Vobecky
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Factor Vii ◽  
Membrane Oxygenation

Extracorporeal membrane oxygenation and cyanotic congenital heart disease

1992 ◽  
Vol 2 (4) ◽  
pp. 359-360 ◽  
Author(s):  
Gale A. Pearson ◽  
Richard K. Firmin ◽  
Ranjit Leanage
Keyword(s):  
Congenital Heart Disease ◽  
United Kingdom ◽  
Heart Disease ◽  
Extracorporeal Membrane Oxygenation ◽  
Congenital Heart ◽  
Cyanotic Congenital Heart Disease ◽  
Membrane Oxygenation ◽  
The United Kingdom

AbstractWorldwide figures suggest that two percent of appropriate referrals for neonatal extracorporeal membrane oxygenation turn out to have previously covert congenital heart disease. This is despite the fact that expert cardiological evaluation is routine prior to cannulation. The experience in the United Kingdom includes such a case which is reported here. The implications for the role of pediatric cardiologists in such a service are considered.

The Evolving Role of Extracorporeal Membrane Oxygenation in Lung Transplantation: Implications for Anesthetic Management

2019 ◽  
Vol 33 (7) ◽  
pp. 1995-2006 ◽  
Author(s):  
Jacobo Moreno Garijo ◽  
Marcelo Cypel ◽  
Karen McRae ◽  
Tiago Machuca ◽  
Valerie Cunningham ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Lung Transplantation ◽  
Anesthetic Management ◽  
Membrane Oxygenation

Predictive value of scoring tools in determining heparin-induced thrombocytopenia in patients on extracorporeal membrane oxygenation

Perfusion ◽  
2019 ◽  
Vol 35 (5) ◽  
pp. 378-383 ◽  
Author(s):  
Jaclyn Sullivan ◽  
Erica Bak ◽  
Mary Jane Sullivan ◽  
Payal K. Gurnani
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Predictive Value ◽  
Medical Center ◽  
High Sensitivity ◽  
Serotonin Release ◽  
Heparin Induced Thrombocytopenia ◽  
Membrane Oxygenation ◽  
Observational Cohort ◽  
Post Cardiopulmonary Bypass ◽  
Scoring Tools

There are currently no scoring tools validated for use in predicting heparin-induced thrombocytopenia in patients receiving extracorporeal membrane oxygenation. This study aims to determine the predictive value of the Warkentin 4T score, Lilo-Le Louet score, and the heparin-induced thrombocytopenia expert probability score in detecting heparin-induced thrombocytopenia in patients on extracorporeal membrane oxygenation. This was a single center, retrospective, observational cohort study of patients at Rush University Medical Center. Heparin-induced thrombocytopenia–positive patients were defined as those with an optical density greater than or equal to 0.4, consistent with a positive anti-platelet 4 heparin antibody. Out of 39 patients on extracorporeal membrane oxygenation with suspected heparin-induced thrombocytopenia, six (15.4%) were found to be anti-platelet 4–positive. A heparin-induced thrombocytopenia diagnosis was confirmed by serotonin-release assay in two patients (5.1%). The 4T, heparin-induced thrombocytopenia expert probability, and Lilo-Le Louet scoring tools all demonstrated a low positive predictive value (21.4%, 16.7%, and 6.7%, respectively), with the 4T and heparin-induced thrombocytopenia expert probability scores demonstrating the highest specificity (66.7% and 84.8%, respectively) and lowest sensitivity (50% and 16.7%, respectively). The Lilo-Le Louet score had high sensitivity (100%) and low specificity (12.5%) in post-cardiopulmonary bypass patients. Based on the findings of this study, all three scoring tools have limited utility for predicting heparin-induced thrombocytopenia in patients on extracorporeal membrane oxygenation.

The role of extracorporeal membrane oxygenation in severe pulmonary coccidioidomycosis

Heart & Lung ◽  
2018 ◽  
Vol 47 (3) ◽  
pp. 261-263 ◽  
Author(s):  
Alex Studemeister ◽  
Lucy Studemeister ◽  
Francisco Brun
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Membrane Oxygenation
Sign in / Sign up

Export Citation Format

Share Document