Extracorporeal Membrane Oxygenation Induces Short-Term Loss of High-Molecular-Weight von Willebrand Factor Multimers

Tauber, Helmuth; Ott, Helmut W.; Streif, Werner; Weigel, Guenter; Loacker, Lorin; Fritz, Josef; Heinz, Anneliese; Velik‐Salchner, Corinna

doi:10.1213/ane.0000000000000554

Cited by 94 publications

(74 citation statements)

References 24 publications

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“…This is not in keeping with the broader ICU literature where placebo-controlled trials of thromboprophylaxis have demonstrated a clear reduction in DVT prevalence when anticoagulation was used (5). It is possible that the size of this study precludes being able to demonstrate any association, and it also possible that other unmeasured hemostatic deficits, such as acquired von Willebrand factor deficiency, may have modified the risk (9).…”

Section: Discussionmentioning

confidence: 63%

Prevalence of Venous Thrombosis Following Venovenous Extracorporeal Membrane Oxygenation in Patients With Severe Respiratory Failure

Cooper

Burns²,

Retter³

et al. 2015

Critical Care Medicine

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Section: Discussionmentioning

confidence: 63%

Prevalence of Venous Thrombosis Following Venovenous Extracorporeal Membrane Oxygenation in Patients With Severe Respiratory Failure

Cooper

Burns²,

Retter³

et al. 2015

Critical Care Medicine

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“…The main mechanisms are anticoagulation, thrombocytopenia and coagulation factor consumption. ECMO circuits are also responsible for impaired platelet function [39] and biological acquired von Willebrand syndrome (AVWS) [40, 41]. However, a study by Abrams et al [42] reported that severity of critical illness and platelet count at the time of cannulation, rather than ECMO duration, were the best predictors for development of severe thrombocytopenia while receiving ECMO for respiratory failure.…”

Section: Outcomes Of Severe Ards Patients With and Without Ecmomentioning

confidence: 99%

Outcomes and survival prediction models for severe adult acute respiratory distress syndrome treated with extracorporeal membrane oxygenation

et al. 2016

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Extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) has known a growing interest over the last decades with promising results during the 2009 A(H1N1) influenza epidemic. Targeting populations that can most benefit from this therapy is now of major importance.Survival has steadily improved for a decade, reaching up to 65% at hospital discharge in the most recent cohorts. However, ECMO is still marred by frequent and significant complications such as bleeding and nosocomial infections. In addition, physiological and psychological symptoms are commonly described in long-term follow-up of ECMO-treated ARDS survivors. Because this therapy is costly and exposes patients to significant complications, seven prediction models have been developed recently to help clinicians identify patients most likely to survive once ECMO has been initiated and to facilitate appropriate comparison of risk-adjusted outcomes between centres and over time. Higher age, immunocompromised status, associated extra-pulmonary organ dysfunction, low respiratory compliance and non-influenzae diagnosis seem to be the main determinants of poorer outcome.

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“…12 Nearly all patients treated with MCS develop acquired von Willebrand syndrome with loss of high molecular weight von Willebrand factor multimers (Table 1). [13][14][15][16][17][18][19] The exception may be the Syncardia TAH, as three patients with normal von Willebrand multimers after TAH implantation have been reported. 20 The severity of acquired von Willebrand syndrome is similar between the HeartMate II and HVAD devices.…”

Section: Effects Of Mcs On the Hematologic Systemmentioning

confidence: 99%

Mechanical circulatory support: balancing bleeding and clotting in high-risk patients

Kreuziger

Massicotte

2015

Hematology

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Mechanical circulatory support (MCS) provides a bridge to heart transplant in children and adults with life-threatening heart failure and sustains patients ineligible for transplant. Extracorporeal membrane oxygenation (ECMO) provides temporary support for patients in cardiac or pulmonary failure through external gas exchange and continuous flow of blood. Because the median time to heart transplant exceeds event-free time on ECMO, pulsatile left ventricular assist devices (LVADs) are used to support infants and children. Continuous flow LVADs are preferred in adolescents and adults due to increased pump durability and improved overall survival. The shear stress created by the mechanical pumps cause changes in the hematologic system; acquired von Willebrand syndrome occurs in almost all patients treated with MCS. Despite the improvements in survival, major bleeding occurs in one-third of patients with a LVAD and ischemic stroke and LVAD thrombosis can affect 12% of adults and 29% of children. An antithrombotic strategy to mitigate LVAD bleeding and thrombotic complications has been tested in a randomized trial in children, but intensity of antithrombotic therapy in adults varies widely. Consensus guidelines for antithrombotic therapy during ECMO were created due to significant differences in management across centers. Because of the high risk for both bleeding and thrombotic complications, experts in hemostasis can significantly impact care of patients requiring mechanical circulatory support and are a necessary part of the management team. Learning Objectives• Understand available options for mechanical circulatory support and the impact of mechanical circulatory support on the hematologic system • Differentiate the bleeding and thrombotic risks between children and adults requiring mechanical circulatory support • Recognize possible treatment options for mechanical circulatory support thrombosis Heart failure affects Ͼ5 million adults in the United States (US) and 23 million people globally. 1 The incidence of heart failure in children is significantly less than adults with ϳ18 admissions per 100 000 children per year; however, there is significant economic impact of pediatric heart failure given the frequent need for surgical intervention and the loss of productive years in the event of a child's death. 2 The heart failure etiology also differs with age as most children have congenital heart disease and adults experience cardiomyopathy or coronary artery disease. 1

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Extracorporeal Membrane Oxygenation Induces Short-Term Loss of High-Molecular-Weight von Willebrand Factor Multimers

Cited by 94 publications

References 24 publications

Prevalence of Venous Thrombosis Following Venovenous Extracorporeal Membrane Oxygenation in Patients With Severe Respiratory Failure

Prevalence of Venous Thrombosis Following Venovenous Extracorporeal Membrane Oxygenation in Patients With Severe Respiratory Failure

Outcomes and survival prediction models for severe adult acute respiratory distress syndrome treated with extracorporeal membrane oxygenation

Mechanical circulatory support: balancing bleeding and clotting in high-risk patients

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