The hemostatic system represents a main problem in ECMO as the foreign surface of the extracorporeal circuit activates platelets and the clotting system. Bleeding and/or thrombosis are frequent complications in ECMO patients. Purpose of this study was to investigate platelet function and clotting system, assessed by thrombelastometry and by aPTT point-of-care (POC) device, in adult patients undergoing ECMO. Five male patients (median age: 60 yrs, 23 – 72 yrs) were rescued by ECMO emergently. Four patients suffered from severe cardiac shock (3 due to acute coronary syndrome and 1 due to congenital heart disease); the fifth suffered from severe respiratory distress. The ECMO mean duration was 9.2±6.0 days. In all patients the whole blood levels of lactate was <2 mmol/L. Anticoagulation was accomplished with unfractionated heparin and was titrated to an aPTT of 50-60 s. Thromboelastometry was performed by a 4-channel analyzer (ROTEM). For each session 4 tests were performed: native blood (recalcification alone, NaTEM assay), extrinsic and intrinsic activity (ExTEM and InTEM assays) and the assessment of heparin therapy (ExTEM in the presence of heparinase, EpTEM). The onset of coagulation (coagulation time, CT), kinetics of clot formation (CF), maximum clot firmness (MCF), and α-angle were measured. APTT was measured in ward by using POC coagulometer (Hemochron, ITC). The comparison between first (1 to 3 hours after the beginning of ECMO) and last (3 hours after the end) measurements of ROTEM showed a restoring of normal hemostatic profile in all parameters examined in the 3 survivors at discharge of ECMO. In the 2 patients died during ECMO overall alterations of hemostasis observed at the first measurement persisted. These data indicate that a close monitoring of hemostasis by the combination of aPTT and modified TEG in adult patients on ECMO could be useful to early identify hemostatic complications.

Close monitoring of hemostasis by thromboelastometry during extracorporeal membrane oxygenation (ECMO) / R. Paniccia; E. Antonucci; N. Maggini; S. Bevilacqua; M. Bonacchi; G. Sani; G. Olivo; D. Prisco; R. Abbate; G.F. Gensini. - In: JOURNAL OF THROMBOSIS AND HAEMOSTASIS. SUPPLEMENT. - ISSN 1740-3340. - STAMPA. - (2009), pp. PP-TH-352-PP-TH-352.

Close monitoring of hemostasis by thromboelastometry during extracorporeal membrane oxygenation (ECMO)

PANICCIA, RITA;BONACCHI, MASSIMO;SANI, GUIDO;PRISCO, DOMENICO;ABBATE, ROSANNA;GENSINI, GIAN FRANCO
2009

Abstract

The hemostatic system represents a main problem in ECMO as the foreign surface of the extracorporeal circuit activates platelets and the clotting system. Bleeding and/or thrombosis are frequent complications in ECMO patients. Purpose of this study was to investigate platelet function and clotting system, assessed by thrombelastometry and by aPTT point-of-care (POC) device, in adult patients undergoing ECMO. Five male patients (median age: 60 yrs, 23 – 72 yrs) were rescued by ECMO emergently. Four patients suffered from severe cardiac shock (3 due to acute coronary syndrome and 1 due to congenital heart disease); the fifth suffered from severe respiratory distress. The ECMO mean duration was 9.2±6.0 days. In all patients the whole blood levels of lactate was <2 mmol/L. Anticoagulation was accomplished with unfractionated heparin and was titrated to an aPTT of 50-60 s. Thromboelastometry was performed by a 4-channel analyzer (ROTEM). For each session 4 tests were performed: native blood (recalcification alone, NaTEM assay), extrinsic and intrinsic activity (ExTEM and InTEM assays) and the assessment of heparin therapy (ExTEM in the presence of heparinase, EpTEM). The onset of coagulation (coagulation time, CT), kinetics of clot formation (CF), maximum clot firmness (MCF), and α-angle were measured. APTT was measured in ward by using POC coagulometer (Hemochron, ITC). The comparison between first (1 to 3 hours after the beginning of ECMO) and last (3 hours after the end) measurements of ROTEM showed a restoring of normal hemostatic profile in all parameters examined in the 3 survivors at discharge of ECMO. In the 2 patients died during ECMO overall alterations of hemostasis observed at the first measurement persisted. These data indicate that a close monitoring of hemostasis by the combination of aPTT and modified TEG in adult patients on ECMO could be useful to early identify hemostatic complications.
2009
R. Paniccia; E. Antonucci; N. Maggini; S. Bevilacqua; M. Bonacchi; G. Sani; G. Olivo; D. Prisco; R. Abbate; G.F. Gensini
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/780642
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