ECMO Biocompatibility: Surface Coatings, Anticoagulation, and Coagulation Monitoring

Maul, Timothy; Massicotte, M. Patricia; Wearden, Peter D.

doi:10.5772/63888

Cited by 42 publications

(43 citation statements)

References 146 publications

(172 reference statements)

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“…Platelet and coagulation cascade activation promote clot formation in the oxygenator and induce the risk of thromboembolism. Advances in biomaterials have led to the development of circuit components with surface-bonded anticoagulants that may reduce the risk of clot formation (26). Despite these improvements, anticoagulation remains common practice for patients on ECMO to reduce thromboembolic risk and extend oxygenator lifespan.…”

Section: Ecmo Circuit Complicationsmentioning

confidence: 99%

Contemporary approaches in the use of extracorporeal membrane oxygenation to support patients waiting for lung transplantation

Keller

2020

Ann Cardiothorac Surg

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The introduction of the lung allocation score in 2005 prioritized patients with decreased transplant-free survival as the recipients of donor organs and effectively increased the number of critically-ill patients with end-stage lung disease waiting for transplantation. This change presented transplant programs with the challenge of how to both extend the lives of critically-ill, end-stage lung disease patients waiting for donor organs and maintain patient vitality to survival through the rigors of surgery and post-transplant recovery. Motivated by the dismal outcomes of patients maintained on mechanical ventilation pre-transplant, transplant centers increasingly deploy extracorporeal membrane oxygenation (ECMO) as a means of supporting patients with advanced disease as a bridge to successful lung transplantation. ECMO is an extracorporeal gas exchange device providing delivery of oxygen and removal of carbon dioxide from blood passed through the circuit. The specific cannulation strategy determines whether ECMO provides primarily respiratory or circulatory support. The cannulation approach is tailored to the specific physiological manifestations of the pre-lung transplant candidate's disease process. For patients with profound hypoxic respiratory failure, a cannulation strategy that captures a large fraction of the venous return is required to maintain adequate support whereas lower circuit flows are sufficient for patients with predominantly hypercapnic respiratory failure. Improving outcomes and increasing experience with ECMO is motivating transplant centers to initiate support before patients require mechanical ventilation. Awake cannulation is increasingly common and is used to avoid the complications associated with intubation in advanced lung failure. Determining criteria for initiation of support and identifying the optimal approach to support patients with right heart failure in need of circulatory support are avenues of active investigation. Use of ECMO and other forms of extracorporeal support are rapidly becoming a mainstay in the care of the prelung transplant patient with advanced disease.

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Section: Ecmo Circuit Complicationsmentioning

confidence: 99%

Contemporary approaches in the use of extracorporeal membrane oxygenation to support patients waiting for lung transplantation

Keller

2020

Ann Cardiothorac Surg

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“…Their use in TBI patients could be consider, however clinical trials should be done. The three synthetic anticoagulants used have been argatroban, bivalirudin and lepirudin [31][32][33][34]. Argatroban has been most often cited new anticoagulants in ECLS applications [31,35].…”

Section: Anticoagulation Choichesmentioning

confidence: 99%

Extra Corporeal Life Support in Traumatic Brain Injury Patients

López¹,

Torre²,

Bilotta³

et al. 2019

obm neurobiol

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Purpose of review: The purpose of this review is to describe recent evidence regarding the use of Extracorporeal Membrane Oxygenation (ECMO) as rescue therapy for refractory cardiac or respiratory failure in patients with traumatic brain injury (TBI) when conventional treatments have failed. The characteristics of these patients, including the risk of bleeding and developing malignant intracranial hypertension, are generally considered as relative contraindications to ECMO treatment; however, recent evidence suggests that the use of ECMO should be considered even in this cohort. Recent findings: Recent findings suggest that venous-venous (V-V) ECMO can be feasible in the treatment of severe acute respiratory distress syndrome (ARDS) TBI-related. Venousarterial (V-A) ECMO has emerged as a salvage intervention in TBI patients complicated with cardiogenic shock and after cardiac arrest. Improvement of ECMO techniques, including the introduction of centrifugal pumps and heparin-coated circuits, are progressively reducing the amount of heparin required. Moreover, the application of low dose heparin or heparinfree protocols anticoagulation in ECMO has shown good outcome and minimal bleeding and thrombotic complications. Summary: ECMO can be considered as a safe and feasible rescue therapy even in TBI patients. However, there is a lack of evidence. Further studies are warranted, focusing on brain trauma patients undergoing ECMO to better clarify the effect on survival, the type and dose of anticoagulation, and the utility of dedicated multidisciplinary trauma-ECMO units.

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“…Imaging of patients on ECMO, with an emphasis on assessing for cardiac recovery and prognosis, is especially important and discussed by Dr. Luigi, while the actual techniques, concepts, and applications of various weaning strategies are the focus of another chapter. Meanwhile, Dr. Weller's chapter on anticoagulation in the pediatric patient and Dr. Pinto's chapter on neurologic complications and monitoring revisit some of the difficult topics addressed in the previous editions and emphasize the growing experiences and literature in these complex topics [4,5]. As some aspects of these topics have been addressed in the earlier books in this series, the contemporary experiences highlight that there remains much to understand and learn about many of these topics.…”

Section: Introductionmentioning

confidence: 99%

Introductory Chapter: ECMO – Rapidly Evolving Technology, Expanding Indications, and Growing Challenges

Firstenberg¹,

Hanna²

2019

Advances in Extracorporeal Membrane Oxygenation - Volume 3

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ECMO Biocompatibility: Surface Coatings, Anticoagulation, and Coagulation Monitoring

Cited by 42 publications

References 146 publications

Contemporary approaches in the use of extracorporeal membrane oxygenation to support patients waiting for lung transplantation

Contemporary approaches in the use of extracorporeal membrane oxygenation to support patients waiting for lung transplantation

Extra Corporeal Life Support in Traumatic Brain Injury Patients

Introductory Chapter: ECMO – Rapidly Evolving Technology, Expanding Indications, and Growing Challenges

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