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Extracorporeal membrane oxygenation (ECMO) support is often associated with bleeding complications caused by secondary or primary hemostasis pathology. However, there are limited data investigating primary hemostasis using Multiplate aggregometry with specific diagnostics tests for vWF (von Willebrand factor) deficiency.The aim of this study was to find out whether short-term ECMO produces the pathology of primary hemostasis that is detected by Multiplate aggregometry and to investigate the pathology of vWF.In this study, blood samples of 20 patients undergoing lung transplantations with short-term perioperative ECMO support were analyzed. The multimeric structure, the levels of von Willebrand factor antigen (vWF), ristocetin cofactor (RCo), collagen-binding protein (CB), and the results of multiple electrode aggregometry RISTO (ristocetin), ADP (adenosine diphosphate), ASPI (Aspirin®; arachidonic acid), and TRAP (thrombin receptor activating peptide) tests were compared to the samples obtained before and after ECMO support.The Multiplate ADP and RISTO tests showed the presence of significant pathology in primary hemostasis after surgery (p 0.05), suggesting the presence of acquired platelet dysfunction. Although the RISTO tests suggest the presence of acquired vWF deficiency, laboratory tests for vWF antigen and RCo and CB tests showed an increase in this case. The multimeric structure of vWF did not show clinically significant deterioration.Multiple aggregometry ADP, ASPI, and TRAP tests seem to be able to detect primary hemostasis pathology (platelets aggregation and adhesion pathology) that is present during short-term perioperative ECMO support in lung transplantation procedures. Interestingly, RISTO tests seem to be more suitable for the diagnosis of platelet dysfunction than the diagnosis of acquired vWF deficiency in this situation.

BACKGROUND: The shortage of blood products has become a worldwide problem, especially during the COVID-19 Pandemic. Here, we investigated whether a point of care (POC) approach to perioperative bleeding and coagulopathy based on rotational thromboelastometry (ROTEM) results could decrease perioperative blood loss and the perioperative consumption of blood products during lung transplantation. METHODS: Patients undergoing bilateral lung transplantation were randomized into two groups: In the first group, designated the "non POC" group, the management of perioperative bleeding and coagulopathy was based on the clinical experience of the anesthesiologist; in the second group, designated the "POC" group, the management of perioperative bleeding, and coagulopathy was based on the ROTEM results. RESULTS: After performing an interim statistical analysis, the project was prematurely terminated as the results were significantly in favor of the POC approach. Data were analyzed for the period January 2018 until June 2020 when 67 patients were recruited into the study. There was significantly decreased perioperative blood loss in the POC group (n = 31 patients) with p = 0.013, decreased perioperative consumption of RBC with p = 0.009, and decreased perioperative consumption of fresh frozen plasma with p < 0.0001 (practically no fresh frozen plasma was used in the POC group) without deteriorating clot formation in secondary and primary hemostasis as compared to the non POC group (n = 36). CONCLUSION: POC management of perioperative bleeding and coagulopathy based on ROTEM results is a promising strategy to decrease perioperative blood loss and the consumption of blood products in lung transplantation.

In the microbiological diagnosis of bloodstream infections (BSI), blood culture (BC) is considered the gold standard test despite its limitations such as low sensitivity and slow turnaround time. A new FDA‐cleared and CE‐marked platform utilizing magnetic resonance to detect amplified DNA of the six most common and/or problematic BSI pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Escherichia coli; referred to as ESKAPEc) is available and may shorten the time to diagnosis and potentially improve antimicrobial utilization. Whole blood samples from hospitalized patients with clinical signs of sepsis were analyzed using the T2Bacteria Panel (T2Biosystems) and compared to simultaneously collected BC. Discrepant results were evaluated based on clinical infection criteria, combining supporting culture results and the opinion of treating physicians. A total of 55 samples from 53 patients were evaluated. The sensitivity and specificity of the T2Bacteria panel was 94% (16 out of 17 detections of T2Bacteria‐targeted organisms) and 100%, respectively, with 36.4% (8 of 22) causes of BSI detected only by this method. The T2Bacteria Panel detected pathogens on average 55 hours faster than standard BC. In our study, 9 of 15 patients with positive T2Bacteria Panel results received early‐targeted antibiotic therapy and/or modification of antimicrobial treatment based on T2Bacteria Panel findings. Given the high reliability, faster time to detection, and easy workflow, the technique qualifies as a point‐of‐care testing approach., The T2Bacteria Panel allows for fast and reliable detection of the six most common bloodstream infection pathogens. Its sensitivity of on‐panel pathogens was 94% compared with blood cultures (53%). It detected pathogens on average 55 hours faster than using standard blood cultures. Given the high reliability, faster time to detection and easy workflow, the technique qualifies as a point‐of‐care testing approach.

In the microbiological diagnosis of bloodstream infections (BSI), blood culture (BC) is considered the gold standard test despite its limitations such as low sensitivity and slow turnaround time. A new FDA-cleared and CE-marked platform utilizing magnetic resonance to detect amplified DNA of the six most common and/or problematic BSI pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Escherichia coli) is available and may shorten the time to diagnosis and potentially improve antimicrobial utilization. Whole blood samples from hospitalized patients with clinical signs of sepsis were analyzed using the T2Bacteria Panel (T2Biosystems) and compared to simultaneously collected BC. Discrepant results were evaluated based on clinical infection criteria, combining supporting culture results and the opinion of treating physicians. A total of 55 samples from 53 patients were evaluated. The sensitivity and specificity of the T2Bacteria panel was 94% (16 out of 17 detections of T2Bacteria-targeted organisms) and 100%, respectively, with 36.4% (8 of 22) causes of BSI detected only by this method. The T2Bacteria Panel detected pathogens on average 55 hours faster than standard BC. In our study, 9 of 15 patients with positive T2Bacteria Panel results received early-targeted antibiotic therapy, and/or their antimicrobial treatment was modified based on T2Bacteria Panel findings. Given the high reliability, faster time to detection, and easy workflow, the technique qualifies as a point of care testing approach.

We collected a multi-centric retrospective dataset of patients (N = 213) who were admitted to ten hospitals in Czech Republic and tested positive for SARS-CoV-2 during the early phases of the pandemic in March—October 2020. The dataset contains baseline patient characteristics, breathing support required, pharmacological treatment received and multiple markers on daily resolution. Patients in the dataset were treated with hydroxychloroquine (N = 108), azithromycin (N = 72), favipiravir (N = 9), convalescent plasma (N = 7), dexamethasone (N = 4) and remdesivir (N = 3), often in combination. To explore association between treatments and patient outcomes we performed multiverse analysis, observing how the conclusions change between defensible choices of statistical model, predictors included in the model and other analytical degrees of freedom. Weak evidence to constrain the potential efficacy of azithromycin and favipiravir can be extracted from the data. Additionally, we performed external validation of several proposed prognostic models for Covid-19 severity showing that they mostly perform unsatisfactorily on our dataset.

We collected a multi-centric retrospective dataset of patients (N = 213) who were admitted to ten hospitals in Czech Republic and tested positive for SARS-CoV-2. The dataset contains baseline patient characteristics, breathing support required, pharmacological treatment received and multiple markers on daily resolution. Patients in the dataset were treated with hydroxychloroquine (N = 108), azithromycin (N = 72), favipiravir (N = 9), convalescent plasma (N = 7), dexamethasone (N = 4) and remdesivir (N = 3), often in combination. Most patients were admitted during the first wave of the epidemic. To explore association between treatments and patient outcomes we performed multiverse analysis, observing how the conclusions change between defensible choices of statistical model, predictors included in the model and other analytical degrees of freedom. Weak evidence to constrain the potential efficacy of azithromycin and favipiravir can be extracted from the data. Additionally, we performed external validation of several proposed prognostic models for Covid-19 severity showing that they mostly perform unsatisfactorily on our dataset.

Extracorporeal membrane oxygenation (ECMO) use during lung transplantation surgery produces primary hemostasis pathology detected by a PFA 200. The PFA 200 results return to the preoperative values soon after ECMO explantation. This phenomenon of primary hemostasis pathology detected by the PFA 200 was successfully used to prevent circuit thrombosis in patients on prolonged ECMO with respiratory or cardiac failure without the use of unfractionated heparin.

Purpose Primary Graft Dysfunction (PGD) is the most common complication during the first 72 hours after lung transplant. Amount of perioperative blood loss and blood product administration may be some of the causes. Intravascular volume during surgery and in ICU is usually maintained by the administration of crystalline and colloids solutions and by administration of fresh frozen plasma (FFP) due to coagulopathy. In the field of the allogenic ischemic organ FFP essentially becomes another allogenic material and can cause undesired immunomodulation and contribute to the development of PGD. Nowadays point of care (POC) management of coagulopathy and bleeding is available using methods such as thromboelastometry (ROTEM), platelet function analyzer (PFA 200) and agregometer (Multiplate) which contribute to the optimalization of blood products and coagulation factors administration. The purpose of this study is to find out if POC management of perioperative bleeding and coagulopathy can reduce postoperative PGD development and length of artificial ventilation. Methods 18 patients undergoing bilateral lung transplantation were randomized into 2 groups. In the first group (9 subj) the management of perioperative bleeding or coagulopathy and volume replacement strategy were based on clinical experience of the anesthesiologist - standard approach. In the second group (9 subj) the management of perioperative bleeding and coagulopathy was based on the results of POC methods. Albumin 5% solution was preferably used for volume replacement therapy. Results In the POC management group PGD development, length of artificial ventilation and langht of stay was significantly reduced. Conclusion POC management of perioperative bleeding or coagulopathy and volume replacement strategy with Albumin 5% significantly reduce PGD development and decrease length of stay and artificial ventilation.

Purpose Lung transplantation is often accompanied with significant bleeding and coagulopathy. Perioperative management usually consists of administering of fresh frozen plasma (FFP) and red blood cells. However, usage of blood transfusion products, especially FFP, may be associated with higher morbidity of patient. Point of care (POC) monitoring of coagulopathy by thrombelastometry (ROTEM), platelet function analyzer (PFA 200) and agregometer (Multiplate) and subsequent aimed therapy may lead to decreased consumption of FFP. The purpose of this study is to investigate if POC based monitoring and treatment of coagulopathy may decrease consumption of FFP, APACHE II (Acute Physiology and Chronic Health Evaluation) and SOFA (Sequential Organ Failure Assessment) scores. Methods Patients undergoing bilateral lung transplantation were randomized into 2 groups. In the first group (non-POC group) management of bleeding and coagulopathy was based on anesthesiologist´s experience by administering FFP or other coagulation factors. In the second group (POC group) management of coagulopathy was based on results of POC methods such as ROTEM, PFA 200, Multiplate and 5% albumin solution was used to maintain normovolemia. Results Total number of analyzed patients is 46. In POC group no FFP unit was used at all. Admission APACHE II score as well as SOFA score 24 hours after admission was significantly decreased in POC group of patients (p Conclusion Perioperative usage of POC methods such as ROTEM, PFA 200 and Multiplate to diagnose and treat coagulopathy significantly reduces consumption of FFP and may decrease APACHE II and SOFA score in patients undergoing lung transplantation. The study is registered in clinical trial database with number: CTN03598907.