Externally visible thrombus partially predicts internal thrombus deposition in extracorporeal membrane oxygenators

Evans, C.; Li, Tieluo; Mishra, Vikas; Pratt, Diana L.; Mohammed, Imran; Kon, Zachary N.; Griffith, Bartley P.

doi:10.1177/0267659116678679

Cited by 9 publications

(10 citation statements)

References 6 publications

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“…Neurological complications were the most frequently investigated (seven studies) (17)(18)(21)(22)(23)27,30) , followed by hemorrhagic (three studies) (24,29,32) , kidney (two studies) (26,31) , infectious (two studies) (20,25) , and mechanical (one study) (16) complications. Other complications were identified in the studies and were categorized as "other": formation of a lymphocele (one study) (33) , thrombocytopenia (one study) (19) , and thrombosis or pulmonary thromboembolism (one study) (34) .…”

Section: Sample/ecmo Modality Objective Findings/multivariate Analysimentioning

confidence: 99%

“…The frequency of mechanical complications was presented, because this was a study that used oxygenators to measure the volume of thrombi (16) .…”

Section: Sample/ecmo Modality Objective Findings/multivariate Analysimentioning

confidence: 99%

“…For mechanical complications, one study demonstrated a combination of variables (combination of median flow, VA modality, and increase in visible thrombus) predict the internal volume in the thrombus in the ECMO oxygenator in 39% (16) .…”

Section: Sample/ecmo Modality Objective Findings/multivariate Analysimentioning

confidence: 99%

“…Mechanical complications: Despite the use of continuous anticoagulant and a heparinized ECMO circuit, there is still a chance of thrombus development in the system. Thus, it is challenging for the multiprofessional team to establish an ideal level of anticoagulation, avoiding complications secondary to coagulopathy, bleeding, and the presence of thrombi and fibrin (16) .…”

Section: Predictors Of Complications Associated With Extracorporeal Mmentioning

confidence: 99%

“…The fact that visualization of the thrombus external to the oxygenator is one of the predictors of thrombus volume in the internal part of the system could be an indication for clinical decision-making to replace the oxygenator (16) . In addition, monitoring for formation of visible thrombi in the oxygenator should be intensified during flow reduction at ECMO weaning.…”

Section: Predictors Of Complications Associated With Extracorporeal Mmentioning

confidence: 99%

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Predictors of complications associated with extracorporeal membrane oxygenation

Nakasato

Lopes

2020

Rev. Bras. Enferm.

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Objectives: to identify in the literature, the predictors of ECMO complications in adult patients. Methods: integrative review of literature, including articles in Portuguese, English and Spanish published from 2014 to 2018 in five databases. Included articles which analyzed the predictive factors of ECMO complications in adult patients using multivariate analysis. Results: a total of 1629 articles were identified, of which 19 were included. Nineteen predictors were identified for neurological complications (e.g., post-ECMO hypoglycemia), seven for bleeding complications (e.g., fungal pneumonia), four for infections complications (e.g., preoperative creatinine level), three for kidney complications (e.g., the length of ICU stay> 20 days) and a combination of factors for mechanical complications (e.g., median flow). Conclusions: different predictors were identified to ECMO complications. The knowledge of these predictors enables the individualized targeting of preventive interventions by multidisciplinary team for modifiable factors, as well as intensification of monitoring for early recognition of non-modifiable factors.

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Section: Sample/ecmo Modality Objective Findings/multivariate Analysimentioning

confidence: 99%

“…The frequency of mechanical complications was presented, because this was a study that used oxygenators to measure the volume of thrombi (16) .…”

Section: Sample/ecmo Modality Objective Findings/multivariate Analysimentioning

confidence: 99%

Section: Sample/ecmo Modality Objective Findings/multivariate Analysimentioning

confidence: 99%

Section: Predictors Of Complications Associated With Extracorporeal Mmentioning

confidence: 99%

Section: Predictors Of Complications Associated With Extracorporeal Mmentioning

confidence: 99%

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Predictors of complications associated with extracorporeal membrane oxygenation

Nakasato

Lopes

2020

Rev. Bras. Enferm.

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In-Vitro Visualization of Thrombus Growth in Artificial Lungs Using Real-Time X-Ray Imaging: A Feasibility Study

Kaesler

Rudawski

Zander

et al. 2021

Cardiovasc Eng Tech

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Purpose Extracorporeal membrane oxygenation has gained increasing attention in the treatment of patients with acute and chronic cardiopulmonary and respiratory failure. However, clotting within the oxygenators or other components of the extracorporeal circuit remains a major complication that necessitates at least a device exchange and bears risks of adverse events for the patients. In order to better predict thrombus growth within oxygenators, we present an approach for in-vitro visualization of thrombus growth using real-time X-ray imaging. Methods An in-vitro test setup was developed using low-dose anticoagulated ovine blood and allowing for thrombus growth within 4 h. The setup was installed in a custom-made X-ray setup that uses phase-contrast for imaging, thus providing enhanced soft-tissue contrast, which improves the differentiation between blood and potential thrombus growth. During experimentation, blood samples were drawn for the analysis of blood count, activated partial thromboplastin time and activated clotting time. Additionally, pressure and flow data was monitored and a full 360° X-ray scan was performed every 15 min. Results Thrombus formation indicated by a pressure drop and changing blood parameters was monitored in all three test devices. Red and white thrombi (higher/lower attenuation, respectively) were successfully segmented in one set of X-ray images. Conclusion We showed the feasibility of a new in-vitro method for real-time thrombus growth visualization by means of phase contrast X-ray imaging. In addition, with more blood parameters that are clinically relevant, this approach might contribute to improved oxygenator exchange protocols in the clinical routine.

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Predictors of complications related to venoarterial extracorporeal membrane oxygenation in adults: A multicenter retrospective cohort study

et al. 2020

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Externally visible thrombus partially predicts internal thrombus deposition in extracorporeal membrane oxygenators

Abstract: A multivariable linear regression model suggested that the combination of median flow, configuration of ECMO and visible thrombus partially predicted internal thrombus volume (adjusted R=0.39).

Cited by 9 publications

References 6 publications

Predictors of complications associated with extracorporeal membrane oxygenation

Predictors of complications associated with extracorporeal membrane oxygenation

In-Vitro Visualization of Thrombus Growth in Artificial Lungs Using Real-Time X-Ray Imaging: A Feasibility Study

Predictors of complications related to venoarterial extracorporeal membrane oxygenation in adults: A multicenter retrospective cohort study

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