Challenges with Navigating the Precarious Hemostatic Balance during Extracorporeal Life Support: Implications for Coagulation and Transfusion Management

Andrews, Jennifer; Winkler, Anne

doi:10.1016/j.tmrv.2016.07.005

Cited by 31 publications

(30 citation statements)

References 54 publications

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“…However excess anticoagulation, particularly when administered systemically, may cause bleeding problems . In fact bleeding issues are the most common complication in extracorporeal membrane oxygenation (ECMO), occurring in between 10–30% of cases, and the thrombotic complications that anticoagulation is meant to blunt, commonly lead to reduced device lifespan . The risks associated with limited device blood biocompatibility and the pharmacologic interventions utilized to address this limitation clearly restrict the broader adoption of life saving extracorporeal therapies.…”

Section: Introductionmentioning

confidence: 99%

Development of zwitterionic sulfobetaine block copolymer conjugation strategies for reduced platelet deposition in respiratory assist devices

Malkin

Lee

et al. 2018

J Biomed Mater Res

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Respiratory assist devices, that utilize ∼2 m of hollow fiber membranes (HFMs) to achieve desired gas transfer rates, have been limited in their adoption due to such blood biocompatibility limitations. This study reports two techniques for the functionalization and subsequent conjugation of zwitterionic sulfobetaine (SB) block copolymers to polymethylpentene (PMP) HFM surfaces with the intention of reducing thrombus formation in respiratory assist devices. Amine or hydroxyl functionalization of PMP HFMs (PMP-A or PMP-H) was accomplished using plasma-enhanced chemical vapor deposition. The generated functional groups were conjugated to low molecular weight SB block copolymers with N-hydroxysuccinimide ester or siloxane groups (SBNHS or SBNHSi) that were synthesized using reversible addition fragmentation chain transfer polymerization. The modified HFMs (PMP-A-SBNHS or PMP-H-SBNHSi) showed 80-95% reduction in platelet deposition from whole ovine blood, stability under the fluid shear of anticipated operating conditions, and uninhibited gas exchange performance relative to non-modified HFMs (PMP-C). Additionally, the functionalization and SBNHSi conjugation technique was shown to reduce platelet deposition on polycarbonate and poly(vinyl chloride), two other materials commonly found in extracorporeal circuits. The observed thromboresistance and stability of the SB modified surfaces, without degradation of HFM gas transfer performance, indicate that this approach is promising for longer term pre-clinical testing in respiratory assist devices and may ultimately allow for the reduction of anticoagulation levels in patients being supported for extended periods. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2681-2692, 2018.

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Section: Introductionmentioning

confidence: 99%

Development of zwitterionic sulfobetaine block copolymer conjugation strategies for reduced platelet deposition in respiratory assist devices

Malkin

Lee

et al. 2018

J Biomed Mater Res

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“…Hemolysis occurs frequently in patients who undergo ECMO. It occurs in at least 5 to 10% of patients when measured using free hemoglobin according to ELSO report (Extra-corporeal Life Support Organization) [22] and depends on various technical aspects (size of cannulas, rotation speed). In a cohort study of 50 pediatric patients requiring ECMO, Borasino et al recently found that hemolysis was associated with prolonged need of RRT and death after discharge [23].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with major adverse kidney events in patients who underwent veno-arterial extracorporeal membrane oxygenation

Vinclair

Montmollin

Sonneville

et al. 2020

Ann. Intensive Care

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“…The etiology of bleeding and thrombosis during ECMO support is complex and multifactorial. The contact of blood with the non-endothelial surfaces, even with the use of biocompatible materials, leads to the activation of the coagulation cascade and progressive consumption of coagulation factors and platelets, in addition to excessive fibrinolytic activation (5,6). In these critically-ill patients, impaired organ function, infection/ sepsis and inflammation may further contribute to the disturbance of the inflammation/coagulation system (5,6).…”

Section: Introductionmentioning

confidence: 99%

Traditional and non-traditional anticoagulation management during extracorporeal membrane oxygenation

Koster¹,

Ljajikj²,

Faraoni³

2019

Ann. Cardiothorac. Surg.

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Unfractionated heparin (UFH) is the anticoagulant of choice during extracorporeal membrane oxygenation (ECMO) support. Despite its favorable pharmacologic properties, management of heparin anticoagulation during ECMO remains a major challenge. To date, little is known about the optimal monitoring strategy or the heparin dose offering the best safety/efficacy profile. Therefore, it remains unclear if the heparin dose should be adapted to target a specific "clotting time" [e.g., activated clotting time (ACT) or activated partial thromboplastin time (aPTT)] or a heparin concentration, measured by coagulation factor anti-Xa assay. In addition, no study has compared the relevance of modern viscoelastic coagulation tests over the single value of a clotting time or heparin concentration value. Although guidelines for anticoagulation during ECMO support have been published, the absence of evidence limits the quality of the recommendations provided, which explains the major intra-and inter-institutional variability observed. Large prospective multicenter trials are urgently needed to investigate the optimal anticoagulation management strategy during ECMO support.

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Challenges with Navigating the Precarious Hemostatic Balance during Extracorporeal Life Support: Implications for Coagulation and Transfusion Management

Cited by 31 publications

References 54 publications

Development of zwitterionic sulfobetaine block copolymer conjugation strategies for reduced platelet deposition in respiratory assist devices

Development of zwitterionic sulfobetaine block copolymer conjugation strategies for reduced platelet deposition in respiratory assist devices

Factors associated with major adverse kidney events in patients who underwent veno-arterial extracorporeal membrane oxygenation

Traditional and non-traditional anticoagulation management during extracorporeal membrane oxygenation

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