Early changes in coagulation profiles and lactate levels in patients with septic shock undergoing extracorporeal membrane oxygenation

Kim, Hyoung Soo; Cheon, Dae Young; Ha, Sang Ook; Han, Sang Jin; Kim, Hyun‐Sook; Lee, Sun Hee; Kim, Sung Gyun; Park, Sunghoon

doi:10.21037/jtd.2018.02.28

Cited by 21 publications

(53 citation statements)

References 34 publications

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“…During ECMO in critical care settings numerous artificial procoagulant and anticoagulant factors simultaneously influence the coagulation system. The most significant procoagulant factors during ECMO are a long-lasting blood contact with the synthetic non-endothelial surface of the ECMO circuit, endothelial damage at the site of vessel cannulation, endothelial dysfunction due to biologically active substances, decreased blood flow between the vessel wall and the cannula, the procoagulant effects of free hemoglobin, an ECMO flow of less than 2 L/min, disseminated intravascular coagulation (DIC), heparin-induced thrombocytopenia, thrombin hypersecretion due to activation of white blood cells and the complement system, heparin resistance, and many more [17][18][19][20]. The most significant anticoagulant factors during ECMO are anticoagulation with heparin, thrombocytopenia or thrombocytopathy, decreased concentrations of coagulation factors, including fibrinogen and factor XIII, shear stress phenomenona, acquired Von Willebrand syndrome among others [21,22].…”

Section: Plos Onementioning

confidence: 99%

Clinical and pathophysiologic aspects of ECMO-associated hemorrhagic complications

et al. 2020

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Extracorporeal membrane oxygenation (ECMO) is increasingly used to treat severe cases of acute respiratory or cardiac failure. Hemorrhagic complications represent one of the most common complications during ECMO, and can be life threatening. The purpose of this study was to elucidate pathophysiological mechanisms of ECMO-associated hemorrhagic complications and their impact on standard and viscoelastic coagulation tests. The study cohort included 27 patients treated with VV-ECMO or VA-ECMO. Hemostasis was evaluated using standard coagulation tests and viscoelastic parameters investigated with rotational thromboelastometry. Anticoagulation and hemorrhagic complications were analyzed for up to seven days depending on ECMO duration. Hemorrhagic complications developed in 16 (59%) patients. There were 102 discrete hemorrhagic episodes among 116 24-hour-intervals, of which 27% were considered to be clinically significant. The highest number of ECMO-associated hemorrhages occurred on the 2 nd and 3 rd day of treatment. Respiratory tract bleeding was the most common hemorrhagic complication, occurring in 62% of the 24hour intervals. All 24-hours-intervals were divided into two groups: "with bleeding" and "without bleeding". The probability of hemorrhage was significantly associated with abnormalities of four parameters: increased international normalized ratio (INR, sensitivity 71%, specificity 94%), increased prothrombin time (PT, sensitivity 90%, specificity 72%), decreased intrinsic pathway maximal clot firmness (MCFin, sensitivity 76%, specificity 89%), and increased extrinsic pathway clot formation time (CFTex, sensitivity 77%, specificity 87%). In conclusions, early ECMO-associated hemorrhagic complications are related to one traditional and two novel viscoelastic coagulation abnormalities: PT/INR elevation, reduced maximum clot firmness due to intrinsic pathway dysfunction (MCFin), and prolonged clot formation time due to extrinsic pathway dysfunction (CFTex). When managing hemostasis during ECMO, derangements in PT/INR, MCFin and CFT ex should be focused on.

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Section: Plos Onementioning

confidence: 99%

Clinical and pathophysiologic aspects of ECMO-associated hemorrhagic complications

et al. 2020

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“…The lactate levels in ECMO-supported remained higher than that of the non-ECMO-supported neonates pre-ECMO support, suggesting that neonates in the ECMO-supported group were probably more critically ill than neonates in the non-ECMO supported group. Lactate levels and lactate clearance had been proven to be predictors of mortality in adult patients with ECMO support (20,21). Nonetheless, after propensity matching that OI value and the primary disease causing neonatal ARDS matched, hospital mortality of ECMO-supported neonates (19.4%) was markedly lower than that of the non-ECMO supported neonates (58.1%).…”

Section: Discussionmentioning

confidence: 99%

Venoarterial Extracorporeal Membrane Oxygenation for Severe Neonatal Acute Respiratory Distress Syndrome in a Developing Country

et al. 2020

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Objective: Extracorporeal membrane oxygenation (ECMO) has supported oxygen delivery and carbon dioxide removal in neonatal severe respiratory failure for more than 4 decades. The definition and diagnosis of neonatal acute respiratory distress syndrome (ARDS) was made according to the criteria first established by a Montreux Conference in 2017. By far, there has been no ECMO efficiency studies in neonatal ARDS. We aimed to compare the outcomes of neonates with severe ARDS supported with and without ECMO. Design: Retrospective pair-matched study. Setting: In the present retrospective pair-matched study, the outcomes of severe ARDS with ECMO support and without ECMO support were analyzed and compared. Propensity score matching was conducted. The study subjects were selected from a China Neonatal ECMO (CNECMO) study. In total, five hospitals were included in the CNECMO study. The patients were matched with demographic and clinical data. The primary endpoint was in-hospital mortality. Secondary outcomes included ventilator-time, ICU stay, hospitalization costs and cranial MRI results. Patients: 145 neonates with severe ARDS (Oxygenation Index, OI ≥16) from 5 hospitals. Interventions: No interventions. Measurements and Main Results: We collected the data of 145 neonates with severe ARDS (Oxygenation Index, OI≥16) from 5 hospitals. Among them, 42 neonates received venoarterial (VA) ECMO support, and the remaining 103 neonates were treated with conventional mechanical ventilation. The mortality of ECMO-supported neonates was not significantly different compared with the ESLO neonatal respiratory-supported from 2012 to 2018 (23.8 vs. 32.5%, p = 0.230). After matching with the propensity score we got 31 pairs. The ECMO-supported neonates had a lower in-hospital mortality (6 of 31, 19.4%) vs. non ECMO-supported patients (18 of 31, 58.1%) (p = 0.002). Hospitalization costs of survivors in ECMO-supported neonates were significantly higher than that of non-ECMO-supported neonates (p < 0.001). There was no difference of ventilator-times (p = 0.206), ICU stay (p = 0.879) and cranial MRI (p = 0.899) between the survivors of ECMO-supported and non-ECMO-supported neonates with ARDS. Conclusions: By far, there has been no ECMO efficiency studies in neonatal ARDS. This study found that ECMO-support have superior outcomes compared with non-ECMO-support in neonates with severe ARDS.

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“…ECMO is used to treat a variety of conditions in neonatal patients, including respiratory and cardiac failure as a result of persistent pulmonary hypertension (PPHN), congenital diaphragmatic hernia (CDH), meconium aspiration syndrome (MAS), respiratory distress syndrome (RDS), pneumonia, severe air-leak syndromes, or sepsis [140]. Both bleeding and clotting complications can occur during ECMO support, often coexist in the same patient, and are associated with significant morbidity and mortality [141]. Moreover, patients requiring ECMO are critically ill, thus making it difficult to distinguish the relative contributions of the underlying pathology from that of the ECMO circuit as such.…”

Section: Biomarker Association Referencesmentioning

confidence: 99%

“…Moreover, patients requiring ECMO are critically ill, thus making it difficult to distinguish the relative contributions of the underlying pathology from that of the ECMO circuit as such. Rates of reported ECMOassociated venous thromboembolism (VTE) in general population, ranging from 18 to 85% in various centers, may be at least partly dependent on anticoagulation regimens [141]. Severe hemorrhage is reported in nearly 40% and intracranial hemorrhage in 16-21% of patients [142,143].…”

Section: Biomarker Association Referencesmentioning

confidence: 99%

Platelets in the Newborn

Esiaba¹,

Mousselli²,

Faison³

et al. 2019

Neonatal Medicine

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Platelets were first described in the mid-nineteenth century. Since then, their roles were identified in hemostasis and thrombosis, inflammation, leukocyte interactions, angiogenesis, and cancer growth. But there is little information about such platelet functions in the newborn. Several studies highlighted some platelet differences between newborns and adults. Yet, in spite of these differences, healthy newborns appear to be adequately protected. A number of factors, however, were reported to negatively affect neonatal platelets. These include maternal hypertensive disorders or infections, neonatal asphyxia or respiratory distress, therapies such as ampicillin or indomethacin, and treatment modalities such as ventilators, nitric oxide, or extracorporeal membrane oxygenation (ECMO). Their effects on newborn platelets are usually transitory, lasting from several hours to a few days or weeks. If these effects are well characterized, they could serve as reporters for diagnosis and monitoring during therapy. Careful studies of neonatal platelets are needed to improve the understanding of basic physiology and pathophysiology in this cohort and to identify possible targets for intervention and therapy.

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Early changes in coagulation profiles and lactate levels in patients with septic shock undergoing extracorporeal membrane oxygenation

Abstract: During the early period of ECMO support, the coagulation profiles and lactate levels exhibited different trajectories in survivors and non-survivors. Furthermore, the pre-ECMO DIC score plus lactate level was the best predictor of hospital death.

Cited by 21 publications

References 34 publications

Clinical and pathophysiologic aspects of ECMO-associated hemorrhagic complications

Clinical and pathophysiologic aspects of ECMO-associated hemorrhagic complications

Venoarterial Extracorporeal Membrane Oxygenation for Severe Neonatal Acute Respiratory Distress Syndrome in a Developing Country

Platelets in the Newborn

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