Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)—Comparison of VA- versus VV ECMO

Appelt, Hannah; Philipp, Alois; Mueller, Thomas; Foltan, Maik; Lubnow, Matthias; Lunz, Dirk; Zeman, Florian; Lehle, Karla

doi:10.1371/journal.pone.0227793

Cited by 67 publications

(63 citation statements)

References 30 publications

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“…A retrospective study from 2014 did report an exchange rate due to thrombosis of 27% runs [ 10 ]. Other data suggest pump head thrombosis rate of 9% in V-V ECMO [ 11 ]. A recent paper on COVID-19 reported three thrombotic occlusions of the centrifugal pump in 2/12 ECMO (25% of runs) patients [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Thrombotic circuit complications during venovenous extracorporeal membrane oxygenation in COVID-19

Bemtgen

Zotzmann

Benk

et al. 2020

J Thromb Thrombolysis

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The novel coronavirus SARS-CoV-2 and the resulting disease COVID-19 causes pulmonary failure including severe courses requiring venovenous extracorporeal membrane oxygenation (V-V ECMO). Coagulopathy is a known complication of COVID-19 leading to thrombotic events including pulmonary embolism. It is unclear if the coagulopathy also increases thrombotic circuit complications of the ECMO. Aim of the present study therefor was to investigate the rate of V-V ECMO complications in COVID-19. We conducted a retrospective registry study including all patients on V-V ECMO treated at our centre between 01/2018 and 04/2020. COVID-19 cases were compared non-COVID-19 cases. All circuit related complications resulting in partial or complete exchange of the extracorporeal system were registered. In total, 66 patients were analysed of which 11 (16.7%) were SARS-CoV-2 positive. The two groups did not differ in clinical parameters including age (COVID-19 59.4 vs. non-COVID-19 58.1 years), gender (36.4% vs. 40%), BMI (27.8 vs. 24.2) and severity of illness as quantified by the RESP Score (1pt. vs 1pt.). 28 days survival was similar in both groups (72.7% vs. 58.2%). While anticoagulation was similar in both groups (p = 0.09), centrifugal pump head thrombosis was more frequent in COVID-19 (9/11 versus 16/55 p < 0.01). Neither the time to first exchange (p = 0.61) nor blood flow at exchange (p = 0.68) did differ in both groups. D-dimer levels prior to the thrombotic events were significantly higher in COVID-19 (mean 15.48 vs 26.59, p = 0.01). The SARS-CoV-2 induced infection is associated with higher rates of thrombotic events of the extracorporeal system during V-V ECMO therapy. Keyword V-V ECMO • COVID-19 • Thrombotic complications • Pump head thrombosis Abbreviations aPTT Activated partial thromboplastin time ARDS Acute respiratory distress syndrome COVID-19 Coronavirus disease 2019 ICU Intensive care unit SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 V-V ECMO Venovenous extracorporeal membrane oxygenation Highlights • This study compared the rate of thrombotic circuit complications in COVID-19 V-V ECMO patients to historical controls. • The two groups were comparable.

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Section: Discussionmentioning

confidence: 99%

Thrombotic circuit complications during venovenous extracorporeal membrane oxygenation in COVID-19

Bemtgen

Zotzmann

Benk

et al. 2020

J Thromb Thrombolysis

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“…Several reviews correlate the causes of haemolysis during ECMO support with either high negative access pressures, high pump flows, small cannula size, or pump head thrombosis and high transmembrane pressures with a loss of oxygen transfer [ 24 , 25 , 26 ]. It is interesting to note that haemolysis occurred in this case in the absence of all of these factors.…”

Section: Discussionmentioning

confidence: 99%

The Prolonged Use of VV ECMO Support in COVID-19: A Case Report

Fitzgerald

Vachharajani

Davidson

et al. 2020

The Journal of Critical Care Medicine

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COVID-19 has resulted in unprecedented global health and economic challenges. The reported mortality in patients with COVID-19 requiring mechanical ventilation is high. VV ECMO may serve as a lifesaving rescue therapy for a minority of patients with COVID-19; however, its impact on overall survival of these patients is unknown. To date, few reports describe successful discharge from ECMO in COVID-19 after a prolonged ECMO run. The only Australian case of a COVID-19 patient, supported by prolonged VV ECMO in conjunction with prone ventilation, complicated by significant airway bleeding, and successfully decannulated after forty-two days, is described. VV ECMO is a resource-intense form of respiratory support. Providing complex therapies such as VV ECMO during a pandemic has its unique challenges. This case report provides a unique insight into the potential clinical sequelae of COVID-19, supported in an intensive care environment which was not resource-limited at the time, and adds to the evolving experience of prolonged VV ECMO support for ARDS with a goal to lung recovery.

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“…Once established, hemolysis may lead to acute kidney failure, thrombocytopenia, and reduced survival. Therefore, it should be avoided as much as possible ( 11 – 13 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report First-in-Man Method Description: Left Ventricular Unloading With iVAC2L During Veno-Arterial Extracorporeal Membrane Oxygenation: From Veno-Arterial Extracorporeal Membrane Oxygenation to ECMELLA to EC-iVAC®

Tschöpe

Alogna

Faragli

et al. 2020

Front. Cardiovasc. Med.

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Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly used in bi-ventricular failure with cardiogenic shock to maintain systemic perfusion. Nonetheless, it tends to increase left ventricular (LV) afterload and myocardial oxygen demand. In order to mitigate these negative effects on the myocardium, an Impella CP ® (3.5 L/min Cardiac Output) can be used in conjunction with V-A ECMO (ECMELLA approach). We implemented this strategy in a patient with severe acute myocarditis complicated by cardiogenic shock. Due to a hemolysis crisis, Impella CP ® had to be substituted with PulseCath iVAC2L ® , which applies pulsatile flow to unload the LV. A subsequent improvement in LV systolic function was noted, with increased LV ejection fraction (LVEF), LV end-diastolic diameter (LVEDD) reduction, and a reduction in plasma free hemoglobin. This case documents the efficacy of iVAC2L in replacing Impella CP as a LV vent during V-A ECMO, with less hemolysis.

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Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)—Comparison of VA- versus VV ECMO

Cited by 67 publications

References 30 publications

Thrombotic circuit complications during venovenous extracorporeal membrane oxygenation in COVID-19

Thrombotic circuit complications during venovenous extracorporeal membrane oxygenation in COVID-19

The Prolonged Use of VV ECMO Support in COVID-19: A Case Report

Case Report First-in-Man Method Description: Left Ventricular Unloading With iVAC2L During Veno-Arterial Extracorporeal Membrane Oxygenation: From Veno-Arterial Extracorporeal Membrane Oxygenation to ECMELLA to EC-iVAC®

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