Severe Respiratory Failure, Extracorporeal Membrane Oxygenation, and Intracranial Hemorrhage*

Lockie, Christopher; Gillon, Stuart; Barrett, Nicholas; Taylor, Daniel; Mazumder, Asif; Paramesh, Kaggere; Rowland, Katie; Daly, Kathleen; Camporota, Luigi; Meadows, Christopher I. S.; Glover, Guy; Ioannou, Nicholas; Langrish, C.; Tricklebank, Stephen; Retter, Andrew; Wyncoll, Duncan

doi:10.1097/ccm.0000000000002579

Cited by 83 publications

(100 citation statements)

References 16 publications

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“…In our study, only 30-day, but not 180-day, mortality of patients with ICH at the time of initiation of VV-ECMO was significantly higher compared with patients without ICH (37.5% vs 16.5%; p ¼ 0.03). Overall 71.8% (107 of 149 patients) of those who received VV-ECMO treatment survived at 6 months with no significant difference between the patients with or without ], respectively) are much higher in our cohort of patients compared with other reported studies 10,11,23 except the more recent report from Lockie et al 6 in which 250 patients receiving VV-ECMO had a 6-month survival of 68.3% with ICH versus 76.0% without.…”

Section: Discussioncontrasting

confidence: 57%

“…Despite increasing experience with VV-ECMO and recent technical improvements, the morbidity and mortality of patients receiving VV-ECMO remain high, but vary significantly between centers, patient subgroups, and by underlying disease pathology. [1][2][3][4][5][6] The outcome of patients on VV-ECMO is influenced not only by factors independent of VV-ECMO (e.g., illness type and severity, other organ support) but also by complications arising from VV-ECMO itself. Mechanical complications of VV-ECMO have decreased with introduction of centrifugal pumps, low-resistance polymethylpentene membranes, and modern heparin-coated surfaces.…”

mentioning

confidence: 99%

“…The bleeding and thrombotic complications of VV-ECMO are now a leading cause of morbidity and mortality. 9 Intracranial hemorrhage (ICH) has been reported with an incidence ranging from 5% 10,11 up to 19%, 6,12,13 with a predominantly fatal outcome. Data from the 2013 Extracorporeal Life Support Organization (ELSO) registry showed that bleeding was the principal complication of VV-ECMO therapy.…”

mentioning

confidence: 99%

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Intracranial Hemorrhage and Early Mortality in Patients Receiving Extracorporeal Membrane Oxygenation for Severe Respiratory Failure

Arachchillage

Passariello

Laffan

et al. 2018

Semin Thromb Hemost

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Intracranial hemorrhage (ICH) is a serious complication in patients receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO) and is associated with high mortality. It is unknown whether ICH may be a consequence of the ECMO or of an underlying disease. The authors first aimed to assess the incidence of ICH at initiation and during the course of VV-ECMO and its associated mortality. The second aim was to identify clinical and laboratory measures that could predict the development of ICH in severe respiratory failure. Data were collected from a total number of 165 patients receiving VV-ECMO from January, 2012 to December, 2016 in a single tertiary center and treated according to a single protocol. Only patients who had a brain computed tomography within 24 hours of initiation of ECMO ( = 149) were included for analysis. The prevalence and incidence of ICH at initiation and during the course of VV-ECMO (at median 9 days) were 10.7% (16/149) and 5.2% (7/133), respectively. Thrombocytopenia and reduced creatinine clearance (CrCL) were independently associated with increased risk of ICH on admission; odds ratio (95% confidence interval): 22.6 (2.6-99.5), and 10.8 (5.6-16.2). Only 30-day (not 180-day) mortality was significantly higher in patients with ICH on admission versus those without (37.5% [6/16] vs 16.4% [22/133]; = 0.03 and 43.7% [7/16] vs 26.3% [35/133]; = 0.15, respectively). Reduced CrCL and thrombocytopenia were associated with ICH at initiation of VV-ECMO. The higher incidence of ICH at initiation suggests it is more closely related to the severity of the underlying lung injury than to the VV-ECMO itself. ICH at VV-ECMO initiation was associated with early mortality.

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Section: Discussioncontrasting

confidence: 57%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Intracranial Hemorrhage and Early Mortality in Patients Receiving Extracorporeal Membrane Oxygenation for Severe Respiratory Failure

Arachchillage

Passariello

Laffan

et al. 2018

Semin Thromb Hemost

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“…The bleeding risk remains, with major hemorrhage rates of 19% being reported in a recent systematic review and meta‐analysis 9 . Intracranial hemorrhage rates are a concern on VV ECMO, with rates approaching 16% in patients with severe acute respiratory distress syndrome (ARDS) 10 . Indication and patient population heavily confound risk.…”

Section: Contemporary Ecmo Uses and Circuit Designsmentioning

confidence: 99%

Hematologic concerns in extracorporeal membrane oxygenation

Sniderman

Monagle

Annich

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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This ISTH “State of the Art” review aims to critically evaluate the hematologic considerations and complications in extracorporeal membrane oxygenation (ECMO). ECMO is experiencing a rapid increase in clinical use, but many questions remain unanswered. The existing literature does not address or explicitly state many pertinent details that may influence hematologic complications and, ultimately, patient outcomes. This review aims to broadly introduce modern ECMO practices, circuit designs, circuit materials, hematologic complications, transfusion‐related considerations, age‐ and size‐related differences, and considerations for choosing outcome measures. Relevant studies from the 2019 ISTH Congress in Melbourne, which further advanced our understanding of these processes, will also be highlighted.

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“…59 A strategy including the use of a low target for anticoagulation (aPTT: 40-60 seconds) was associated with a lower rate of hemorrhagic complications compared with similar cohorts in the literature in a recent retrospective cohort. 60 As thrombocytopenia and low fibrinogen are consistently associated with ICH, [61][62][63] relatively liberal platelet and cryoprecipitate transfusion thresholds may be reasonable until more data are available. Of note, transfusion of platelets was discouraged in EOLIA unless patients developed bleeding in the presence of "severe" thrombocytopenia.…”

Section: Patient Management During Vv-ecls Hemostasismentioning

confidence: 99%

Extracorporeal Strategies in Acute Respiratory Distress Syndrome

Cavayas

Thakore

Fan

2019

Semin Respir Crit Care Med

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Despite the breadth of life-sustaining interventions available, mortality in patients with acute respiratory distress syndrome (ARDS) remains high. A greater appreciation of the potential iatrogenic injury associated with the use of mechanical ventilation has led clinicians and researchers to seek alternatives. Extracorporeal life support (ECLS) may be used to rescue patients with severely impaired gas exchange and provide time for injured lungs to recover while treating the underlying disease. In patients with ARDS, venovenous (VV) ECLS is commonly used, where venous blood is drained into a circuit that passes through a membrane lung, which provides gas exchange, and then returned to the venous system. VV-ECLS can be configured as a system that uses higher blood flows with extracorporeal membrane oxygenation (VV-ECMO) or as one that uses lower blood flows for extracorporeal carbon dioxide removal (VV-ECCO2R). Recent studies support the use of VV-ECMO in patients with severe ARDS who present with refractory gas exchange despite the use of lung-protective mechanical ventilation, positive end-expiratory pressure optimization, neuromuscular blockade, and prone positioning. The optimal management of patients during ECLS (i.e., anticoagulation, transfusions, mechanical ventilation) and the role of ECCO2R in the management of ARDS remain to be determined.

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Severe Respiratory Failure, Extracorporeal Membrane Oxygenation, and Intracranial Hemorrhage*

Cited by 83 publications

References 16 publications

Intracranial Hemorrhage and Early Mortality in Patients Receiving Extracorporeal Membrane Oxygenation for Severe Respiratory Failure

Intracranial Hemorrhage and Early Mortality in Patients Receiving Extracorporeal Membrane Oxygenation for Severe Respiratory Failure

Hematologic concerns in extracorporeal membrane oxygenation

Extracorporeal Strategies in Acute Respiratory Distress Syndrome

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