Assistance extracorporelle au cours du syndrome de détresse respiratoire aiguë (chez l’adulte et l’enfant, à l’exclusion du nouveau-né). Conférence de consensus organisée par la Société de réanimation de langue française

Richard, Christian; Argaud, Laurent; Blet, Alice; Boulain, Thierry; Contentin, L.; Dechartres, Agnès; Dejode, Jean-Marc; Donetti, L.; Fartoukh, Muriel; Fletcher, Dominique; Kuteifan, Khaldoun; Lasocki, Sigismond; Liet, Jean-Michel; Lukaszewicz, Anne‐Claire; Mal, Hervé; Maury, Éric; Osman, David; Outin, Hervé; Richard, Jean‐Christophe; Schneider, Francis; Tamion, Fabienne

doi:10.1016/j.rmr.2014.05.004

Cited by 13 publications

(4 citation statements)

References 58 publications

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“…Based on the significantly higher mean anti-Xa value in the bleeding group, we hypothesize that anticoagulation goals may be revised. In VV-ECMO patients, the mean anti-Xa activity was in the range from 0.2 to 0.4 IU/mL, recommended in this setting [ 17 ], and lower than the critical value of 0.46 IU/mL observed in our population. However, the threshold of anti-Xa activity could be lower in VV-ECMO.…”

Section: Discussioncontrasting

confidence: 55%

“…Biological samples to guide anticoagulation must include ACT, activated partial thromboplastin time (aPTT) or anti-Xa activity [ 15 ], which seems to be more accurate in the ICU setting [ 16 ]. Targets used by most of ELSO centers are between 0.3 to 0.7 IU/mL for VA-ECMO [ 15 ], and targets recommended by some societies for VV-ECMO are 0.2 to 0.4 [ 17 ]. Despite these guidelines, anticoagulation targets strongly differ between medical teams and countries due to anchored practices.…”

Section: Introductionmentioning

confidence: 99%

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Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study

et al. 2021

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Background Hemorrhagic events remain a major concern in patients under extracorporeal membrane oxygenation (ECMO) support. We tested the association between anticoagulation levels and hemorrhagic events under ECMO using anti-Xa activity monitoring. Methods We performed a retrospective multicenter cohort study in three ECMO centers. All adult patients treated with veno-venous (VV)- or veno-arterial (VA)-ECMO in 6 intensive care units between September 2017 and August 2019 were included. Anti-Xa activities were collected until a hemorrhagic event in the bleeding group and for the duration of ECMO in the non-bleeding group. All dosages were averaged to obtain means of anti-Xa activity for each patient, and patients were compared according to the occurrence or not of bleeding. Results Among 367 patients assessed for eligibility, 121 were included. Thirty-five (29%) presented a hemorrhagic complication. In univariate analysis, anti-Xa activities were significantly higher in the bleeding group than in the non-bleeding group, both for the mean anti-Xa activity (0.38 [0.29–0.67] vs 0.33 [0.22–0.42] IU/mL; p = 0.01) and the maximal anti-Xa activity (0.83 [0.47–1.46] vs 0.66 [0.36–0.91] IU/mL; p = 0.05). In the Cox proportional hazard model, mean anti-Xa activity was associated with bleeding (p = 0.0001). By Kaplan–Meier analysis with the cutoff value at 0.46 IU/mL obtained by ROC curve analysis, the probability of survival under ECMO without bleeding was significantly lower when mean anti-Xa was > 0.46 IU/mL (p = 0.0006). Conclusion In critically ill patients under ECMO, mean anti-Xa activity was an independent risk factor for hemorrhagic complications. Anticoagulation targets could be revised downward in both VV- and VA-ECMO.

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Section: Discussioncontrasting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study

et al. 2021

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“…Aujourd'hui, dans le SDRA majeur [22], un accord global préconise donc une ECMO veino-veineuse à haut débit (3-7 L/min) en cas d'hypoxémie majeure (rapport PaO 2 /FiO 2 < 50 mmHg sous FiO 2 = 1) pendant au moins 3 heures et réfractaire à une ventilation protectrice optimisée (pression de plateau < 30 cmH 2 O, PaCO 2 < 80 mmHg) comportant notamment le décubitus ventral [29]. Par ailleurs, la réflexion sur cette stratégie peut s'envisager dans une situation où un patient présente un rapport PaO 2 /FiO 2 < 80 mmHg pendant 6 heures et/ou une acidose respiratoire avec un pH < 7,20 (conférence de consensus SDRA) [10]. Des réflexions pour proposer cette technique en cas d'atteinte de la mécanique respiratoire avec l'existence de pressions de plateau élevées sont en cours.…”

Section: Hypoxémie Sévère Et Sdraunclassified

“…L'objectif de cette revue est de dresser le portrait actuel de cette technique encore réservée aux situations les plus graves et les challenges qu'elle pose au pneumologue et au réanimateur aujourd'hui. Nous aborderons notamment la place de l'ECMO dans la prise en charge du SDRA qui a fait l'objet d'une conférence de consensus nationale très récente [10], ainsi que les indications de l'assistance respiratoire extracorporelle (ECMO ou décarboxylation) au cours des décompensations respiratoires terminales hypercapniques et de la transplantation pulmonaire.…”

Section: Introductionunclassified

Place de l’assistance extracorporelle en pathologie respiratoire

Guen

Parquin

2015

Revue des Maladies Respiratoires

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Extra-corporeal membrane oxygenation (ECMO) effectively replaces the lung in providing oxygenation and carbon dioxide (CO2) removal. For some years, and in parallel to the H1N1 influenza pandemic, this technique has gained interest in relation to significant technological improvements, leading to new concepts of "awake and mobile ECMO" or rehabilitation with ECMO. Finally, the publication of randomized controlled trials giving encouraging results in the adult respiratory distress syndrome (ARDS) has helped to validate this technique and further studies are warranted. This general review aims to outline the definition, classification and principles of ECMO and to give some current information about the indications and possibilities of the technique to the pulmonologist and intensivist. Further possible uses for this technique include extra-corporeal removal of CO2 during hypercapnic respiratory failure and assistance during lung transplantation from the preoperative to the early postoperative period.

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Erstellung einer S3-Leitlinie „Einsatz der extrakorporalen Zirkulation (ECLS/ECMO) bei Herz- und Kreislaufversagen“

Boeken

Ensminger

Burckhardt

et al. 2016

Z Herz- Thorax- Gefäßchir

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Assistance extracorporelle au cours du syndrome de détresse respiratoire aiguë (chez l’adulte et l’enfant, à l’exclusion du nouveau-né). Conférence de consensus organisée par la Société de réanimation de langue française

Cited by 13 publications

References 58 publications

Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study

Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study

Place de l’assistance extracorporelle en pathologie respiratoire

Erstellung einer S3-Leitlinie „Einsatz der extrakorporalen Zirkulation (ECLS/ECMO) bei Herz- und Kreislaufversagen“

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