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Hemostasis changes during veno-venous extracorporeal membrane oxygenation for respiratory support in adults.
- Source :
-
Minerva anestesiologica [Minerva Anestesiol] 2016 Feb; Vol. 82 (2), pp. 170-9. Date of Electronic Publication: 2015 May 20. - Publication Year :
- 2016
-
Abstract
- Background: We investigated the coagulation system in patients during extracorporeal membrane oxygenation (ECMO) initiated for respiratory failure and the influence of the ECMO circuit on coagulation tests; we compared different coagulation tests for monitoring unfractionated heparin (UH) therapy; we investigated whether or not coagulation parameters were predictive of bleeding during ECMO.<br />Methods: Pilot study on twelve consecutive adult patients admitted at our general ICU for acute respiratory failure and placed on ECMO from November 2011 to October 2012. Coagulation tests were performed before ECMO start and daily, including day of circuit change and day of circuit removal. UH was monitored with activated partial thromboplastin time (APTT) ratio, at a therapeutic range of 1.5-2.0.<br />Results: We observed no effect of ECMO circuit on coagulation parameters measured pre- and postlung, but platelet count decreased significantly over time (-82x10(3)/mmc, 95%CI 40-123). APTT showed a correlation with antifactor Xa activity, whereas other global coagulation tests such as activated clotting time, thromboelastography and endogenous thrombin potential did not. Major bleeding occurred in three patients but no difference in any coagulation parameter was observed between them and those who did not bleed.<br />Conclusions: This pilot study shows that ECMO initiated for respiratory support in adults does not change coagulation parameters. Over time a statistically significant reduction of platelet count was observed, possibly due to consumption within the circuit, consumption microangiopathy or the underlying patients' diseases. Although APTT was appropriate to monitor UH, major bleedings occurred and a lower therapeutic range may be advisable.
- Subjects :
- Adult
Aged
Aged, 80 and over
Anticoagulants
Blood Coagulation
Female
Humans
Male
Middle Aged
Platelet Count
Pulmonary Disease, Chronic Obstructive therapy
Respiratory Distress Syndrome therapy
Respiratory Insufficiency blood
Respiratory Insufficiency therapy
Extracorporeal Membrane Oxygenation methods
Hemostasis
Respiration, Artificial methods
Subjects
Details
- Language :
- English
- ISSN :
- 1827-1596
- Volume :
- 82
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Minerva anestesiologica
- Publication Type :
- Academic Journal
- Accession number :
- 25990432