Priya Nair1, Dominik Johannes Hoechter2, Hergen Buscher3, Karthik Venkatesh4, Susan Whittam5, Joanne Joseph6, Paul Jansz7. 1. Intensive Care Unit, St Vincents Hospital, Sydney, Australia; University of New South Wales, Australia. Electronic address: pnair@stvincents.com.au. 2. Department of Anesthesiology, University of Munich (LMU), Munich, Germany. 3. Intensive Care Unit, St Vincents Hospital, Sydney, Australia; University of New South Wales, Australia. 4. University of New South Wales, Australia. 5. Intensive Care Unit, St Vincents Hospital, Sydney, Australia. 6. University of New South Wales, Australia; Department of Hematology, St Vincents Hospital, Sydney, Australia. 7. University of New South Wales, Australia; Department of Cardiothoracic Surgery, St Vincents Hospital, Sydney, Australia.
Abstract
OBJECTIVES: To characterize the longitudinal hemostatic profile during adult ECMO using point-of-care tests (POCT) for coagulation and to compare these parameters to standard laboratory tests. In addition, the clinicians' responses during bleeding episodes using available information were compared to a POCT-based response. DESIGN: Prospective observational cohort study. SETTING: ECMO-referral center in a university teaching hospital. PARTICIPANTS: Ten critically ill adult ECMO patients. INTERVENTIONS: Daily laboratory coagulation profile, transfusion history and near-daily thromboelastometry (ROTEM®) and platelet aggregometry (Multiplate®). MAIN RESULTS: Six male and four female patients, seven with VA- and three with VV-ECMO were studied over 110 days. Seventy-five thromboelastometry (TEM) and 36 platelet aggregometry (MEA) results were analyzed. A majority of TEM values were within the normal range, except for FIBTEM (majority high), which remained consistent over long (>5 days) ECMO runs. In MEA there were low values, particularly in the adenosine diphosphate- and ristocetin-induced assay, implying possibly a vWF-factor or GpIb-receptor defect. There was correlation between laboratory and POCT as well as good correlation between the clot firmness after 10 minutes (A10) and the maximum clot firmness in ROTEM, suggesting that reliable information can be obtained within 15 minutes. Twenty-two bleeding episodes were observed in five patients. When comparing the clinicians' response to a transfusion algorithm based on POCT, there was a concordance in less than 20% of episodes. CONCLUSIONS: POCT for coagulation can provide specific, reliable, and timely information during bleeding episodes and the use of targeted therapy algorithms could improve outcomes and reduce costs. Crown
OBJECTIVES: To characterize the longitudinal hemostatic profile during adult ECMO using point-of-care tests (POCT) for coagulation and to compare these parameters to standard laboratory tests. In addition, the clinicians' responses during bleeding episodes using available information were compared to a POCT-based response. DESIGN: Prospective observational cohort study. SETTING: ECMO-referral center in a university teaching hospital. PARTICIPANTS: Ten critically ill adult ECMO patients. INTERVENTIONS: Daily laboratory coagulation profile, transfusion history and near-daily thromboelastometry (ROTEM®) and platelet aggregometry (Multiplate®). MAIN RESULTS: Six male and four female patients, seven with VA- and three with VV-ECMO were studied over 110 days. Seventy-five thromboelastometry (TEM) and 36 platelet aggregometry (MEA) results were analyzed. A majority of TEM values were within the normal range, except for FIBTEM (majority high), which remained consistent over long (>5 days) ECMO runs. In MEA there were low values, particularly in the adenosine diphosphate- and ristocetin-induced assay, implying possibly a vWF-factor or GpIb-receptor defect. There was correlation between laboratory and POCT as well as good correlation between the clot firmness after 10 minutes (A10) and the maximum clot firmness in ROTEM, suggesting that reliable information can be obtained within 15 minutes. Twenty-two bleeding episodes were observed in five patients. When comparing the clinicians' response to a transfusion algorithm based on POCT, there was a concordance in less than 20% of episodes. CONCLUSIONS: POCT for coagulation can provide specific, reliable, and timely information during bleeding episodes and the use of targeted therapy algorithms could improve outcomes and reduce costs. Crown
Authors: Marianne E Nellis; Arun Saini; Philip C Spinella; Peter J Davis; Marie E Steiner; Marisa Tucci; Melissa Cushing; Pierre Demaret; Simon J Stanworth; Stephane Leteurtre; Oliver Karam Journal: Pediatr Crit Care Med Date: 2020-03 Impact factor: 3.624
Authors: Rubens Carmo Costa-Filho; Hugo Caire Castro-Faria Neto; José Mengel; Marcelo Pelajo-Machado; Marco Aurélio Martins; Érica Távora Leite; Hugo Tannus Mendonça-Filho; Tatiana de Arruda Campos Brasil de Souza; Gonzalo Bentacor Bello; José Paulo Gagliardi Leite Journal: Mem Inst Oswaldo Cruz Date: 2021-04-30 Impact factor: 2.743