BACKGROUND: We investigated the coagulation system in patients during extracorporeal membrane oxygenation (ECMO) initiated for respiratory failure and the influence of the ECMO circuit on coagulation tests; we compared different coagulation tests for monitoring unfractionated heparin (UH) therapy; we investigated whether or not coagulation parameters were predictive of bleeding during ECMO. METHODS: Pilot study on twelve consecutive adult patients admitted at our general ICU for acute respiratory failure and placed on ECMO from November 2011 to October 2012. Coagulation tests were performed before ECMO start and daily, including day of circuit change and day of circuit removal. UH was monitored with activated partial thromboplastin time (APTT) ratio, at a therapeutic range of 1.5-2.0. RESULTS: We observed no effect of ECMO circuit on coagulation parameters measured pre- and postlung, but platelet count decreased significantly over time (-82x10(3)/mmc, 95%CI 40-123). APTT showed a correlation with antifactor Xa activity, whereas other global coagulation tests such as activated clotting time, thromboelastography and endogenous thrombin potential did not. Major bleeding occurred in three patients but no difference in any coagulation parameter was observed between them and those who did not bleed. CONCLUSIONS: This pilot study shows that ECMO initiated for respiratory support in adults does not change coagulation parameters. Over time a statistically significant reduction of platelet count was observed, possibly due to consumption within the circuit, consumption microangiopathy or the underlying patients' diseases. Although APTT was appropriate to monitor UH, major bleedings occurred and a lower therapeutic range may be advisable.
BACKGROUND: We investigated the coagulation system in patients during extracorporeal membrane oxygenation (ECMO) initiated for respiratory failure and the influence of the ECMO circuit on coagulation tests; we compared different coagulation tests for monitoring unfractionated heparin (UH) therapy; we investigated whether or not coagulation parameters were predictive of bleeding during ECMO. METHODS: Pilot study on twelve consecutive adult patients admitted at our general ICU for acute respiratory failure and placed on ECMO from November 2011 to October 2012. Coagulation tests were performed before ECMO start and daily, including day of circuit change and day of circuit removal. UH was monitored with activated partial thromboplastin time (APTT) ratio, at a therapeutic range of 1.5-2.0. RESULTS: We observed no effect of ECMO circuit on coagulation parameters measured pre- and postlung, but platelet count decreased significantly over time (-82x10(3)/mmc, 95%CI 40-123). APTT showed a correlation with antifactor Xa activity, whereas other global coagulation tests such as activated clotting time, thromboelastography and endogenous thrombin potential did not. Major bleeding occurred in three patients but no difference in any coagulation parameter was observed between them and those who did not bleed. CONCLUSIONS: This pilot study shows that ECMO initiated for respiratory support in adults does not change coagulation parameters. Over time a statistically significant reduction of platelet count was observed, possibly due to consumption within the circuit, consumption microangiopathy or the underlying patients' diseases. Although APTT was appropriate to monitor UH, major bleedings occurred and a lower therapeutic range may be advisable.
Authors: Gennaro Martucci; Artur Słomka; Steven Eric Lebowitz; Giuseppe Maria Raffa; Pietro Giorgio Malvindi; Valeria Lo Coco; Justyna Swol; Ewa Żekanowska; Roberto Lorusso; Waldemar Wierzba; Piotr Suwalski; Mariusz Kowalewski Journal: Adv Exp Med Biol Date: 2021 Impact factor: 2.622
Authors: Darryl Abrams; Matthew R Baldwin; Matthew Champion; Cara Agerstrand; Andrew Eisenberger; Matthew Bacchetta; Daniel Brodie Journal: Intensive Care Med Date: 2016-03-23 Impact factor: 17.440
Authors: Franziska C Trudzinski; Peter Minko; Daniel Rapp; Sebastian Fähndrich; Hendrik Haake; Myriam Haab; Rainer M Bohle; Monika Flaig; Franziska Kaestner; Robert Bals; Heinrike Wilkens; Ralf M Muellenbach; Andreas Link; Heinrich V Groesdonk; Christian Lensch; Frank Langer; Philipp M Lepper Journal: Ann Intensive Care Date: 2016-07-19 Impact factor: 6.925
Authors: Margaret R Passmore; Yoke L Fung; Gabriela Simonova; Samuel R Foley; Sara D Diab; Kimble R Dunster; Michelle M Spanevello; Charles I McDonald; John-Paul Tung; Natalie M Pecheniuk; Karen Hay; Kiran Shekar; John F Fraser Journal: Crit Care Date: 2017-07-29 Impact factor: 9.097
Authors: Katrina K Ki; Margaret R Passmore; Chris H H Chan; Maximilian V Malfertheiner; Jonathon P Fanning; Mahé Bouquet; Jonathan E Millar; John F Fraser; Jacky Y Suen Journal: Intensive Care Med Exp Date: 2019-08-20