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Erschienen in:

13.07.2022 | Editorial

Bleeding and clotting while supported with ECMO: time to move forward

verfasst von: Elias H. Pratt, John W. Stokes, Eddy Fan

Erschienen in: Intensive Care Medicine | Ausgabe 8/2022

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Excerpt

Patients treated with extracorporeal membrane oxygenation (ECMO) often develop coagulopathies, including alterations in both procoagulant and anticoagulant factors, platelet consumption and platelet dysfunction, hyperfibrinolysis, and acquired Von Willebrand syndrome [1]. Because of this, patients supported with ECMO are at high risk for both bleeding and thrombotic complications. For patients with severe coronavirus disease 2019 (COVID-19), navigating the bleeding and thrombotic complications of ECMO support represents an additional challenge. Critically ill patients with severe COVID-19 may be at increased risk for thrombosis when compared to similar patients without COVID-19 [2]. As the pandemic has progressed and ECMO has increasingly been used to treat patients with respiratory and circulatory failure from severe COVID-19 [3], some have suggested that these patients in particular may be at an increased risk of thrombotic complications, and thus require alternative anticoagulation strategies [4]. …
Literatur
1.
Zurück zum Zitat Thomas J, Kostousov V, Teruya J (2018) Bleeding and thrombotic complications in the use of extracorporeal membrane oxygenation. Semin Thromb Hemost 44(1):20–29CrossRef Thomas J, Kostousov V, Teruya J (2018) Bleeding and thrombotic complications in the use of extracorporeal membrane oxygenation. Semin Thromb Hemost 44(1):20–29CrossRef
2.
Zurück zum Zitat Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, Merdji H, Clere-Jehl R, Schenck M, Fagot Gandet F et al (2020) High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med 46(6):1089–1098CrossRef Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, Merdji H, Clere-Jehl R, Schenck M, Fagot Gandet F et al (2020) High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med 46(6):1089–1098CrossRef
3.
Zurück zum Zitat Barbaro RP, MacLaren G, Boonstra PS, Combes A, Agerstrand C, Annich G, Diaz R, Fan E, Hryniewicz K, Lorusso R et al (2021) Extracorporeal membrane oxygenation for COVID-19: evolving outcomes from the international Extracorporeal Life Support Organization Registry. Lancet 398(10307):1230–1238CrossRef Barbaro RP, MacLaren G, Boonstra PS, Combes A, Agerstrand C, Annich G, Diaz R, Fan E, Hryniewicz K, Lorusso R et al (2021) Extracorporeal membrane oxygenation for COVID-19: evolving outcomes from the international Extracorporeal Life Support Organization Registry. Lancet 398(10307):1230–1238CrossRef
4.
Zurück zum Zitat Bemtgen X, Zotzmann V, Benk C, Rilinger J, Steiner K, Asmussen A, Bode C, Wengenmayer T, Maier S, Staudacher DL (2021) Thrombotic circuit complications during venovenous extracorporeal membrane oxygenation in COVID-19. J Thromb Thrombolysis 51(2):301–307CrossRef Bemtgen X, Zotzmann V, Benk C, Rilinger J, Steiner K, Asmussen A, Bode C, Wengenmayer T, Maier S, Staudacher DL (2021) Thrombotic circuit complications during venovenous extracorporeal membrane oxygenation in COVID-19. J Thromb Thrombolysis 51(2):301–307CrossRef
6.
Zurück zum Zitat Goligher EC, Bradbury CA, McVerry BJ, Lawler PR, Berger JS, Gong MN, Carrier M, Reynolds HR, Kumar A, Turgeon AF et al (2021) Therapeutic anticoagulation with heparin in critically ill patients with Covid-19. N Engl J Med 385(9):777–789CrossRef Goligher EC, Bradbury CA, McVerry BJ, Lawler PR, Berger JS, Gong MN, Carrier M, Reynolds HR, Kumar A, Turgeon AF et al (2021) Therapeutic anticoagulation with heparin in critically ill patients with Covid-19. N Engl J Med 385(9):777–789CrossRef
7.
Zurück zum Zitat McMichael ABV, Ryerson LM, Ratano D, Fan E, Faraoni D, Annich GM (2022) 2021 ELSO adult and pediatric anticoagulation guidelines. ASAIO J 68(3):303–310CrossRef McMichael ABV, Ryerson LM, Ratano D, Fan E, Faraoni D, Annich GM (2022) 2021 ELSO adult and pediatric anticoagulation guidelines. ASAIO J 68(3):303–310CrossRef
8.
Zurück zum Zitat Stokes JW, Gannon WD, Sherrill WH, Armistead LB, Bacchetta M, Rice TW, Semler MW, Casey JD (2020) Bleeding, thromboembolism, and clinical outcomes in venovenous extracorporeal membrane oxygenation. Crit Care Explor 2(11):e0267CrossRef Stokes JW, Gannon WD, Sherrill WH, Armistead LB, Bacchetta M, Rice TW, Semler MW, Casey JD (2020) Bleeding, thromboembolism, and clinical outcomes in venovenous extracorporeal membrane oxygenation. Crit Care Explor 2(11):e0267CrossRef
9.
Zurück zum Zitat Nunez JI, Gosling AF, O’Gara B, Kennedy KF, Rycus P, Abrams D, Brodie D, Shaefi S, Garan AR, Grandin EW (2022) Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis. Intensive Care Med 48(2):213–224CrossRef Nunez JI, Gosling AF, O’Gara B, Kennedy KF, Rycus P, Abrams D, Brodie D, Shaefi S, Garan AR, Grandin EW (2022) Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis. Intensive Care Med 48(2):213–224CrossRef
10.
Zurück zum Zitat Sklar MC, Sy E, Lequier L, Fan E, Kanji HD (2016) Anticoagulation practices during venovenous extracorporeal membrane oxygenation for respiratory failure. A systematic review. Ann Am Thorac Soc 13(12):2242–2250CrossRef Sklar MC, Sy E, Lequier L, Fan E, Kanji HD (2016) Anticoagulation practices during venovenous extracorporeal membrane oxygenation for respiratory failure. A systematic review. Ann Am Thorac Soc 13(12):2242–2250CrossRef
11.
Zurück zum Zitat Hodgson CL, Burrell AJC, Engeler DM, Pellegrino VA, Brodie D, Fan E (2019) Core outcome measures for research in critically ill patients receiving extracorporeal membrane oxygenation for acute respiratory or cardiac failure: an international, multidisciplinary, modified Delphi consensus study. Crit Care Med 47(11):1557–1563CrossRef Hodgson CL, Burrell AJC, Engeler DM, Pellegrino VA, Brodie D, Fan E (2019) Core outcome measures for research in critically ill patients receiving extracorporeal membrane oxygenation for acute respiratory or cardiac failure: an international, multidisciplinary, modified Delphi consensus study. Crit Care Med 47(11):1557–1563CrossRef
Metadaten
Titel
Bleeding and clotting while supported with ECMO: time to move forward
verfasst von
Elias H. Pratt
John W. Stokes
Eddy Fan
Publikationsdatum
13.07.2022
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 8/2022
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-022-06805-y

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