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

Cooper, Eve; Burns, Janis; Retter, Andrew; Salt, Gavin; Camporota, Luigi; Meadows, Christopher I. S.; Langrish, Christopher C. J.; Wyncoll, Duncan; Glover, Guy; Ioannou, Nicholas; Daly, Kathleen; Barrett, Nicholas

doi:10.1097/ccm.0000000000001277

Cited by 83 publications

(72 citation statements)

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“…The incidence was estimated at 8.1/1000 cannula-days and routine venous Doppler ultrasound following decannulation in the VV-ECMO population has been advocated [8]. In addition, haemolysis is commonly observed during VV-ECMO.…”

Section: Outcomes Of Severe Ards Patients With and Without Ecmomentioning

confidence: 99%

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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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Section: Outcomes Of Severe Ards Patients With and Without Ecmomentioning

confidence: 99%

“…1). However, despite these improvements, ECMO is still marred by a high rate of complications such as bleeding, thrombosis and nosocomial infection [6–8]. Moreover, ECMO-treated survivors exhibit significant rates of long-term neuro-psychological and/or physical impairment [7].…”

Section: Introductionmentioning

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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“…Case reports and case series indicate that VT and VTE might influence outcome as well [6][7][8][9][10]. VTE were concurrently diagnosed in up to 10 % of cases [11] and in up to 18 % with routinely performed postdecannulation venous Doppler ultrasound [12]. Autopsy results of patients on veno-arterial ECMO support after cardiac surgery showed VT in 32 % of cases with a duration-dependent increase [13].…”

Section: Introductionmentioning

confidence: 96%

Runtime and aPTT predict venous thrombosis and thromboembolism in patients on extracorporeal membrane oxygenation: A retrospective analysis

Trudzinski

Minko

Rapp

et al. 2016

2.1 Acute Critical Care

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Background: Even though bleeding and thromboembolic events are major complications of extracorporeal membrane oxygenation (ECMO), data on the incidence of venous thrombosis (VT) and thromboembolism (VTE) under ECMO are scarce. This study analyzes the incidence and predictors of VTE in patients treated with ECMO due to respiratory failure. Methods:Retrospective analysis of patients treated on ECMO in our center from 04/2010 to 11/2015. Patients with thromboembolic events prior to admission were excluded. Diagnosis was made by imaging in survivors and postmortem examination in deceased patients.Results: Out of 102 screened cases, 42 survivors and 21 autopsy cases [mean age 46.0 ± 14.4 years; 37 (58.7 %) males] fulfilling the above-mentioned criteria were included. Thirty-four patients (54.0 %) underwent ECMO therapy due to ARDS, and 29 patients (46.0 %) with chronic organ failure were bridged to lung transplantation. Despite systemic anticoagulation at a mean PTT of 50.6 ± 12.8 s, [VT/VTE 47.0 ± 12.3 s and no VT/VTE 53.63 ± 12.51 s (p = 0.037)], VT and/or VTE was observed in 29 cases (46.1 %). The rate of V. cava thrombosis was 15/29 (51.7 %). Diagnosis of pulmonary embolism prevailed in deceased patients [5/21 (23.8 %) vs. 2/42 (4.8 %) (p = 0.036)]. In a multivariable analysis, only aPTT and time on ECMO predicted VT/VTE. There was no difference in the incidence of clinically diagnosed VT in ECMO survivors and autopsy findings.

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“…Patient entry into the SRFC system has implications at both an individual and societal level. Transfer confers inherent risk and distances patients from friends and family; the initiation of VV‐ECMO carries specific risks, such as cardiovascular injury , haemorrhage and venous thrombus formation , and comes at substantial cost to the health system . Decision making at the time of referral must, therefore, seek to select patients for whom SRFC involvement is potentially beneficial.…”

Section: Introductionmentioning

confidence: 99%

Acceptance and transfer to a regional severe respiratory failure and veno‐venous extracorporeal membrane oxygenation (ECMO) service: predictors and outcomes

et al. 2017

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SummaryThe use of extracorporeal membrane oxygenation for respiratory failure is high risk and resource intensive. In England, five centres provide this service and patients who are referred have four possible outcomes: declined transfer due to perceived futility; accepted in principle but remain at the referring centre with ongoing surveillance; retrieved using conventional ventilation; or retrieved on extracorporeal support. The decision-making process leading to these outcomes has not previously been examined. We evaluated referrals to one centre and identified factors associated with each decision outcome. Five hundred and sixty-four patients were analysed from January 2012 to October 2015. One hundred and fifty-seven patients were declined; multivariate analysis demonstrated associated factors to be: age (odds ratio (95% confidence interval) 1.05 (1.04-1.07)); immunocompromise (4.95 (2

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

Abstract: The prevalence of deep vein thrombosis following decannulation from extracorporeal membrane oxygenation for severe respiratory failure is clinically significant, and routine venous Doppler ultrasound following decannulation is warranted in this population.

Cited by 83 publications

References 8 publications

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

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

Runtime and aPTT predict venous thrombosis and thromboembolism in patients on extracorporeal membrane oxygenation: A retrospective analysis

Acceptance and transfer to a regional severe respiratory failure and veno‐venous extracorporeal membrane oxygenation (ECMO) service: predictors and outcomes

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