ECMO in Cardiogenic Shock: Time Course of Blood Biomarkers and Associated Mortality

Bukumirić, Zoran; Breitkopf, Robert; Oezpeker, Ulvi Cenk; Treml, Benedikt

doi:10.3390/diagnostics12122963

Cited by 5 publications

(2 citation statements)

References 36 publications

(50 reference statements)

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“…Evidence if the recommended targets for aPTT-guided anticoagulation are too high is missing, although hemorrhage has been proven to be a significant risk factor of poor patient outcome and mortality during ECMO support [5,6,[31][32][33]. Comparing the adverse events profile or thromboembolic complications only in a recent systemic literature review, the outcome of the patients receiving systemic anticoagulation did not differ from those with an "anticoagulation-free" approach [12].…”

Section: Ecmo Support and Apttmentioning

confidence: 99%

Association of aPTT-Guided Anticoagulation Monitoring with Thromboembolic Events in Patients Receiving V-A ECMO Support: A Systematic Review and Meta-Analysis

Bukumirić

Breitkopf

Treml

et al. 2023

JCM

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Background: The initiation of extracorporeal membrane oxygenation (ECMO) is associated with complex inflammatory and coagulatory processes, raising the need for systemic anticoagulation. The balance of anticoagulatory and procoagulant factors is essential, as therapeutic anticoagulation confers a further risk of potentially life-threatening bleeding. Therefore, our study aims to systematize and analyze the most recent evidence regarding anticoagulation monitoring and the thromboembolic events in patients receiving veno-arterial ECMO support. Methods: Using the PRISMA guidelines, we systematically searched the Scopus and PubMed databases up to October 2022. A weighted effects model was employed for the meta-analytic portion of the study. Results: Six studies comprising 1728 patients were included in the final analysis. Unfractionated heparin was used for anticoagulation, with an activated partial thromboplastin time (aPTT) monitoring goal set between 45 and 80 s. The majority of studies aimed to investigate the incidence of adverse events and potential risk factors for thromboembolic and bleeding events. None of the authors found any association of aPTT levels with the occurrence of thromboembolic events. Finally, the most frequent adverse events were hemorrhage (pooled 43%, 95% CI 28.4; 59.5) and any kind of thrombosis (pooled 36%, 95% CI 21.7; 53.7), and more than one-half of patients did not survive to discharge (pooled 54%). Conclusions: Despite the tremendous development of critical care, aPTT-guided systemic anticoagulation is still the standard monitoring tool. We did not find any association of aPTT levels with thrombosis. Further evidence and new trials should clarify the true incidence of thromboembolic events, along with the best anticoagulation and monitoring strategy in veno-arterial ECMO patients.

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Section: Ecmo Support and Apttmentioning

confidence: 99%

Association of aPTT-Guided Anticoagulation Monitoring with Thromboembolic Events in Patients Receiving V-A ECMO Support: A Systematic Review and Meta-Analysis

Bukumirić

Breitkopf

Treml

et al. 2023

JCM

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“…Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for the aforementioned patients when they present with cardiogenic shock or with cardiac arrest [ 3 ]. There are two different implantation strategies: a central ECMO and a peripheral ECMO.…”

Section: Introductionmentioning

confidence: 99%

Acute Limb Ischaemia during ECMO Support: A 6-Year Experience

Krasivskyi

Großmann

Dechow

et al. 2023

Life

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The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock is rising. Acute limb ischaemia remains one of the main complications after ECMO initiation. We analysed 104 patients from our databank from January 2015 to December 2021 who were supported with mobile ECMO therapy. We aimed to identify the impact of acute limb ischaemia on short-term outcomes in patients placed on ECMO in our institution. The main indication for ECMO therapy was left ventricular (LV) failure with cardiogenic shock (57.7%). Diameters of arterial cannulas (p = 0.365) showed no significant differences between both groups. Furthermore, concomitant intra-aortic balloon pump (IABP, p = 0.589) and Impella (p = 0.385) implantation did not differ significantly between both groups. Distal leg perfusion was established in approximately 70% of patients in two groups with no statistically significant difference (p = 0.960). Acute limb ischaemia occurred in 18.3% of cases (n = 19). In-hospital mortality was not significantly different (p = 0.799) in both groups. However, the bleeding rate was significantly higher (p = 0.005) in the limb ischaemia group compared to the no-limb ischaemia group. Therefore, early diagnosis and prevention of acute limb ischaemia might decrease haemorrhage complications in patients during ECMO therapy.

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