Current and future strategies to monitor and manage coagulation in ECMO patients

Shirejini, Saeedreza Zeibi; Carberry, Josie; McQuilten, Zoe; Burrell, Aidan; Gregory, Shaun D.; Hagemeyer, Christoph E.

doi:10.1186/s12959-023-00452-z

Cited by 16 publications

(26 citation statements)

References 145 publications

(139 reference statements)

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“…However, there is a need for long-term follow-up studies to assess the impact of change-outs on patient survival, organ function, and quality of life. Understanding the long-term consequences and potential complications associated with change-outs can guide decision-making and improve patient counseling and care [25,36,37,38,39,40].…”

Section: Elso Guidelinesmentioning

confidence: 99%

Improving ECMO therapy: Monitoring oxygenator functionality and identifying key indicators, factors, and considerations for changeout

Butt,

Razzaq,

Saleem

et al. 2024

J Extra Corpor Technol

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Introduction: The optimal timing for extracorporeal membrane oxygenation (ECMO) circuit change-out is crucial for the successful management of patients with severe cardiopulmonary failure. This comprehensive review examines the various factors that influence the timing of oxygenator replacement in the ECMO circuit. By considering these factors, clinicians can make informed decisions to ensure timely and effective change-out, enhancing patient outcomes and optimizing the delivery of ECMO therapy. Methodology: A thorough search of relevant studies on ECMO circuit and oxygenator change-out was conducted using multiple scholarly databases and relevant keywords. Studies published between 2017 and 2023 were included, resulting in 40 studies that met the inclusion criteria. Discussion: Thrombosis within the membrane oxygenator and its impact on dysfunction were identified as significant contributors, highlighting the importance of monitoring coagulation parameters and gas exchange. Several factors, including fibrinogen levels, pre and post-membrane blood gases, plasma free hemoglobin, D-dimers, platelet function, flows and pressures, and anticoagulation strategy, were found to be important considerations when determining the need for an oxygenator or circuit change-out. The involvement of a multidisciplinary team and thorough preparation were also highlighted as crucial aspects in this process. Conclusion: In conclusion, managing circuit change-outs in ECMO therapy requires considering factors such as fibrinogen levels, blood gases, plasma free hemoglobin, D-dimers, platelet function, flows, pressures, and anticoagulation strategy. Monitoring these parameters allows for early detection of issues, timely interventions, and optimized ECMO therapy. Standardized protocols, personalized anticoagulation approaches, and non-invasive monitoring techniques can improve safety and effectiveness of circuit change-outs. Further research and collaboration are needed to advance ECMO management and enhance patient outcomes.

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Section: Elso Guidelinesmentioning

confidence: 99%

Improving ECMO therapy: Monitoring oxygenator functionality and identifying key indicators, factors, and considerations for changeout

Butt,

Razzaq,

Saleem

et al. 2024

J Extra Corpor Technol

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“…The monitoring target of the sensor was set to thrombi in an extracorporeal circuit membrane oxygenation (ECMO) as a case study. In extracorporeal circulatory devices such as ECMO, thrombi can occur at various locations including pumps, artificial lungs, and connector gaps, causing serious complications such as thromboinfarction [ 13 , 14 ]. Early thrombus detection is an old challenge, and several methods have been used to detect thrombi in specific parts of ECMO circuits, such as spectral cameras for blood pumps, optical coherence tomography for connector gaps, and ultrasound analysis for blood pumps [ 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…In extracorporeal circulatory devices such as ECMO, thrombi can occur at various locations including pumps, artificial lungs, and connector gaps, causing serious complications such as thromboinfarction [ 13 , 14 ]. Early thrombus detection is an old challenge, and several methods have been used to detect thrombi in specific parts of ECMO circuits, such as spectral cameras for blood pumps, optical coherence tomography for connector gaps, and ultrasound analysis for blood pumps [ 13 , 14 , 15 ]. Such monitoring requires the monitoring of many points, such as tubing with a diameter of approximately 10 mm, blood pumps, artificial lungs with free-form surfaces, narrow internal flow paths, and narrow gaps between these components.…”

Section: Introductionmentioning

confidence: 99%

Design and Fabrication of a Thin and Micro-Optical Sensor for Rapid Prototyping

Morita,

Iwasaki

2023

Sensors

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Optical sensing offers several advantages owing to its non-invasiveness and high sensitivity. The miniaturization of optical sensors will mitigate spatial and weight constraints, expanding their applications and extending the principal advantages of optical sensing to different fields, such as healthcare, Internet of Things, artificial intelligence, and other aspects of society. In this study, we present the development of a miniature optical sensor for monitoring thrombi in extracorporeal membrane oxygenation (ECMO). The sensor, based on a complementary metal-oxide semiconductor integrated circuit (CMOS-IC), also serves as a photodiode, amplifier, and light-emitting diode (LED)-mounting substrate. It is sized 3.8 × 4.8 × 0.75 mm3 and provides reflectance spectroscopy at three wavelengths. Based on semiconductor and microelectromechanical system (MEMS) processes, the design of the sensor achieves ultra-compact millimeter size, customizability, prototyping, and scalability for mass production, facilitating the development of miniature optical sensors for a variety of applications.

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“…Recommended goal for monitoring: >1.5 to 2 times control (no randomized trial for ECMO patients) [11][12][13].…”

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confidence: 99%

Anticoagulation Management in V-V ECMO Patients: A Multidisciplinary Pragmatic Protocol

Rodrigues,

Correia

et al. 2024

JCM

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(1) Background: Extracorporeal membrane oxygenation (ECMO) is a complex procedure affecting both the risk of thrombosis and bleeding. High-quality data to personalize anticoagulation management in ECMO are lacking, resulting in a high variability in practice among centers. For this reason, we review coagulation methods and monitoring and share a pragmatic proposal of coagulation management, as performed in our high-volume ECMO Referral Centre; (2) Methods: We revised the anticoagulation options and monitoring methods available for coagulation management in ECMO through PubMed search based on words including “anticoagulation,” “coagulation assays,” “ECMO,” “ELSO,” and “ISTH”; (3) Results: Actual revision of the literature was described as our routine practice regarding ECMO anticoagulation and monitoring; (4) Conclusions: No coagulation test is exclusively predictive of bleeding or thrombotic risk in patients undergoing ECMO support. An approach that allows for a tailored regimen of anticoagulation (regardless of agent used) and monitoring is mandatory. To accomplish this, we propose that the titration of anticoagulation therapies should include multiple laboratory tests, including anti-Xa, aPTT, ACT, viscoelastic tests, AT levels, platelet count, fibrinogen, and FXIII levels. Anticoagulation regimens should be tailored to a specific patient and personalized based on this complex array of essays.

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Current and future strategies to monitor and manage coagulation in ECMO patients

Cited by 16 publications

References 145 publications

Improving ECMO therapy: Monitoring oxygenator functionality and identifying key indicators, factors, and considerations for changeout

Improving ECMO therapy: Monitoring oxygenator functionality and identifying key indicators, factors, and considerations for changeout

Design and Fabrication of a Thin and Micro-Optical Sensor for Rapid Prototyping

Anticoagulation Management in V-V ECMO Patients: A Multidisciplinary Pragmatic Protocol

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