Platelet Function Disturbance During Veno-Venous ECMO in ARDS Patients Assessed by Multiple Electrode Aggregometry—A Prospective, Observational Cohort Study

Abstract

Extracorporeal (veno-venous) membrane oxygenation (vvECMO) has been shown to have negative effects on platelet number and function. This study aimed to gain more information about the impact of vvECMO on platelet function assessed by multiple electrode aggregometry (MEA). Twenty patients with the indication for vvECMO were included. Platelet function was analyzed using MEA (Multiplate®) before (T-1), 6 h (T0), one (T1), two (T2), three (T3), and seven (T4) days after the beginning of vvECMO. Median aggregational measurements were already below the normal reference range before vvECMO initiation. Platelet aggregation was significantly reduced 6 h after vvECMO initiation compared to T-1 and spontaneously recovered with a significant increase at T2. Platelet count dropped significantly between T-1 and T0 and continuously decreased between T0 and T4. At T4, ADP-induced platelet aggregation showed an inverse correlation with the paO2 in the oxygenator. Platelet function should be assessed by MEA before the initiation of extracorporeal circulation. Although ECMO therapy led to a further decrease in platelet aggregation after 6 h, all measurements had recovered to baseline on day two. This implies that MEA as a whole blood method might not adequately reflect the changes in platelet function in the later stages of extracorporeal circulation.

Platelet Functions During Extracorporeal Membrane Oxygenation. Platelet–Leukocyte Aggregates Analyzed by Flow Cytometry as a Promising Tool to Monitor Platelet Activation

“…There was no difference in platelet aggregation results between patients with and without signs of bleeding. As discussed by the authors, the recovery of platelet aggregation after day two, might be due to a decreasing effect of factors like the initial hemodilution under extracorporeal circulation [14].…”

Factor XIII Activity Might Already Be Impaired before Veno-Venous ECMO in ARDS Patients: A Prospective, Observational Single-Center Cohort Study

“…Part of the study data have been presented to national and international congresses. Data on platelet function using multiple electrode aggregometry (MEA, Multiplate) have been previously published [ 12 ]. The study was registered at German Clinical Trials Register (DRKS00005650), complies with the declaration of Helsinki and was approved by the local Scientific and Ethics Review Board (19/5/13).…”

“…This adds an additional risk of bleeding, since the coagulation system of the critically ill might be already impaired before the initiation of ECMO due to the underlying disease [ 11 ]. The extracorporeal circulation can cause further alterations such as thrombocytopenia, temporary platelet dysfunction, acquired von Willebrand syndrome, as well as factor I and factor XIII (F XIII) deficiencies, which have been described during extracorporeal (veno-venous) membrane oxygenation (vvECMO) therapy [ 9 , 12 , 13 , 14 ]. Bleeding events during the course of treatment are frequent and might lead to premature termination of the technique or have a critical impact on outcome [ 15 , 16 ].…”

Changes in Red Blood Cell Properties and Platelet Function during Extracorporeal Membrane Oxygenation

“…We did not find a time-effect for platelet function during ECMO with the multiplate suggesting a functional balance in the light of developing (mild) thrombocytopenia. This effect was also seen in a study in twenty patients on VV ECMO where platelet function was impaired prior to the ECMO initiation; ECMO led to a further impairment but after two days the values recovered to baseline [15]. In a study with both VV and VA ECMO patients it was shown that the platelet aggregation was not impaired when the results were interpreted considering the low platelet counts [16].…”