Anticoagulation and Transfusion Therapy in Patients Requiring Extracorporeal Membrane Oxygenation

Raiten, Jesse; Wong, Zerlina; Spelde, Audrey E.; Littlejohn, James; Augoustides, John; Gutsche, Jacob T.

doi:10.1053/j.jvca.2016.08.011

Cited by 35 publications

(31 citation statements)

References 69 publications

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“…In recent years, due to the risk of heparin-induced thrombocytopenia and heparin resistance, DTIs have emerged as a safe alternative to heparin in ECMO anticoagulation[39]. In this study, we demonstrated that systemic anticoagulation with bivalirudin, a DTI, did not result in an impairment of CLG.…”

Section: Discussionsupporting

confidence: 46%

Heparin impairs angiogenic signaling and compensatory lung growth after left pneumonectomy

et al. 2018

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Children with hypoplastic lung diseases, such as congenital diaphragmatic hernia, can require life support via extracorporeal membrane oxygenation and systemic anticoagulation, usually in the form of heparin. The role of heparin in angiogenesis and organ growth is inconclusive, with conflicting data reported in the literature. This study aimed to investigate the effects of heparin on lung growth in a model of compensatory lung growth (CLG). Compared to the absence of heparin, treatment with heparin decreased the vascular endothelial growth factor (VEGF)-mediated activation of VEGFR2 and mitogenic effect on human lung microvascular endothelial cells in vitro. Compared to non-heparinized controls, heparinized mice demonstrated impaired pulmonary mechanics, decreased respiratory volumes and flows, and reduced activity levels after left pneumonectomy. They also had lower lung volume, pulmonary septal surface area and alveolar density on morphometric analyses. Lungs of heparinized mice displayed decreased phosphorylation of VEGFR2 compared to the control group, with consequential downstream reduction in markers of cellular proliferation and survival. The use of bivalirudin, an alternative anticoagulant that does not interact with VEGF, preserved lung growth and pulmonary mechanics. These results demonstrated that heparin impairs CLG by reducing VEGFR2 activation. These findings raise concern for the clinical use of heparin in the setting of organ growth or regeneration.

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Section: Discussionsupporting

confidence: 46%

Heparin impairs angiogenic signaling and compensatory lung growth after left pneumonectomy

et al. 2018

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“…Patients on ECLS long-term can develop a complex coagulopathy which can include low platelet function and numbers, fibrinogen deficiency, loss of vitamin K-dependent clotting factors and acquired Von Willebrand's disease (91). The Extracorporeal Life Support Organisation (ELSO) has made recommendations for effective anticoagulation during ECLS applications as well as the management of patient bleeding and circuit clotting.…”

Section: Planning Thoracic Surgery Procedures With Ecls Supportmentioning

confidence: 99%

Principles and indications of extracorporeal life support in general thoracic surgery

McRae¹,

Perrot²

2018

J. Thorac. Dis.

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The role of extracorporeal life support (ECLS) has expanded rapidly over the past 15 years to become an important tool in advanced general thoracic surgery practice. Intra-operative and in some cases continued post-operative ECLS is redefining the scope of complex surgical care. ECLS encompasses a spectrum of temporary mechanical support that may remove CO 2 , oxygenate or provide hemodynamic support or a combination thereof. The most common modalities used in general thoracic surgery include extracorporeal membrane oxygenation (ECMO), interventional lung assist device (iLA ® Novalung ® , Heilbronn, Germany), and extracorporeal CO 2 removal (ECCO 2 R). The ECMO and Novalung ® devices can be used in different modes for the short term or long-term support depending on the situation. In this review, the principles and current applications of ECLS in general thoracic surgery are presented.

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“…Although the rate of ECMO utilization has increased rapidly, establishment of best practices for managing these patients lags behind, both in routine management of anticoagulation and transfusion, 6 as well as in more unique situations such as intraoperative management. Fierro's paper nicely illustrates this lack of consensus, with a fairly large discrepancy in the fundamental anesthetic type that was used (71% of patients received an inhalational anesthetic).…”

mentioning

confidence: 99%

Establishing Best Practices for Patients on ECMO—A Multidisciplinary Challenge

Raiten

Gordon

Gutsche

2019

Journal of Cardiothoracic and Vascular Anesthesia

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Anticoagulation and Transfusion Therapy in Patients Requiring Extracorporeal Membrane Oxygenation

Cited by 35 publications

References 69 publications

Heparin impairs angiogenic signaling and compensatory lung growth after left pneumonectomy

Heparin impairs angiogenic signaling and compensatory lung growth after left pneumonectomy

Principles and indications of extracorporeal life support in general thoracic surgery

Establishing Best Practices for Patients on ECMO—A Multidisciplinary Challenge

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