Severe thrombocytopenia in adults undergoing extracorporeal membrane oxygenation is predictive of thrombosis

Kohs, Tia C L; Liu, Patricia; Raghunathan, Vikram; Amirsoltani, Ramin; Oakes, Michael; McCarty, Owen J. T.; Olson, Sven R.; Masha, Luke; Zonies, David; Shatzel, Joseph J.

doi:10.1080/09537104.2021.1961707

Cited by 17 publications

(14 citation statements)

References 26 publications

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“…In contrast, Cartwright et al reported that routine arterial thrombosis screening by Doppler vascular ultrasound can detect CaAT in up to 41% of patients after cannula removal [16]. In this study, a higher rate of CaAT (61.7%) was found compared to other studies [15,16,17,18]. Surgical vascular closure was performed in the operating room for up to 44.6% of patients undergoing cannula removal.…”

Section: Incidence Of Caatcontrasting

confidence: 70%

Risk Factors of Cannula-associated Arterial Thrombosis following Extracorporeal Membrane Oxygenation support: A Retrospective Study

Trieu¹,

Phan²,

Tran³

et al. 2023

Preprint

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Introduction: Hemostatic dysfunction during extracorporeal membrane oxygenation (ECMO) due to blood-circuit interaction and the consequences of shear stress by flow rates lead to rapid activation of the coagulation cascade and thrombus formation in the ECMO system and blood vessels. In this study, we aimed to identify the incidence and risk factors for cannula-associated arterial thrombosis (CaAT) post-decannulation. Methods: A retrospective study of patients undergoing arterial cannula removal following ECMO. We evaluated the incidence of CaAT and compared clinical characteristics, pre-ECMO severity, and daily hemostasis parameters in patients with and without CaAT. Multivariate analysis revealed the risk factors for CaAT. Results: Forty-seven patients requiring venoarterial ECMO or hybrid methods were recruited to be screened for thrombosis. The median SOFA score was 11 (8-13). CaAT occurred in 29 patients (61.7%), with thrombosis in the superficial femoral artery accounting for 51.7%. Limb ischemia complications in the group with CaAT was 17.2%. In multivariate analysis, an ECMO flow rate of 100 mL/min was determined to be the independent factor for CaAT with an OR of 0.84 (95% CI, 0.73–0.95, p=0.008). Conclusion: In patients successfully weaned from ECMO, the incidence of CaAT was 61.7%. Our study found that a low-flow rate of ECMO was an independent risk factor for CaAT.

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Section: Incidence Of Caatcontrasting

confidence: 70%

Risk Factors of Cannula-associated Arterial Thrombosis following Extracorporeal Membrane Oxygenation support: A Retrospective Study

Trieu¹,

Phan²,

Tran³

et al. 2023

Preprint

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“…Heparin-induced thrombocytopenia is associated with increased risk of arterial thromboembolism, further illustrating the rather unpredictable side effects of prolonged heparin use amid patients [51]. Kohs et al looked at a cohort of 69 patients who were treated with heparin while on VV or VA ECMO [52]. Severe thrombocytopenia was prevalent in 38.8% of patients, with no difference between VV and VA ECMO cohorts, and thrombocytopenia was significantly correlated with subsequent thrombosis in this study [52].…”

Section: Ecmo and Anticoagulationmentioning

confidence: 54%

“…Kohs et al looked at a cohort of 69 patients who were treated with heparin while on VV or VA ECMO [52]. Severe thrombocytopenia was prevalent in 38.8% of patients, with no difference between VV and VA ECMO cohorts, and thrombocytopenia was significantly correlated with subsequent thrombosis in this study [52]. Bidar et al found that patients who were weaned from ECMO who were previously anticoagulated had a significantly reduced risk of developing DVT [23].…”

Section: Ecmo and Anticoagulationmentioning

confidence: 58%

“…Lastly, severe bleeding is a very common complication that is seen in patients supported by ECMO and can require multiple blood transfusions [53]. In particular, patients on heparin concurrently with ECMO are at a high risk of hemorrhage [52]. Because anticoagulants go handin-hand with ECMO therapy, patients often receive anticoagulation prophylactically or therapeutically.…”

Section: Ecmo and Anticoagulationmentioning

confidence: 99%

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Venous thromboembolic events in the setting of extracorporeal membrane oxygenation support in adults: A systematic review

Abruzzo

Gorantla

Thomas

2022

Thrombosis Research

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“…Moreover, another study mentioned that platelets count, bilirubin and creatinine levels were predictors of in-hospital mortality after ECMO implantation [ 30 ]. In addition, Kohs et al found that severe thrombocytopenia was associated with adverse outcomes in patients on ECMO [ 31 ]. Further authors have shown that serum bilirubin elevation was associated with an increased risk of in-hospital mortality after ECMO [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

ECMO Retrieval Program: What Have We Learned So Far

Krasivskyi

Großmann

Dechow

et al. 2023

Life

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Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for patients with cardiogenic shock or cardiac arrest. However, survival rates remain low. It is unclear to what extent ECMO patients benefit from the ECMO team learning curve. Therefore, we aimed to analyze our mobile ECMO program patients from the past seven years to evaluate if a learning curve benefits patients’ outcomes. We analyzed 111 patients from our databank who were supported with a VA-ECMO and brought to our hospital from January 2015 to December 2021. Patients were divided into two groups: survival (n = 70) and non-survival (n = 41). As expected, complications after ECMO implantation were more severe in the non-survivor group. The incidence of thromboembolic events (p = 0.002), hepatic failure (p < 0.001), renal failure (p = 0.002), dialysis (p = 0.002) and systemic inflammatory response syndrome (SIRS, p = 0.044) occurred significantly more often compared with the survivor group. We were able to show that despite our extensive experience in terms of ECMO retrieval program the high mortality and morbidity rates stay fairly the same over the years. This displays that we have to focus even more on patient selection and ECMO indication.

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Severe thrombocytopenia in adults undergoing extracorporeal membrane oxygenation is predictive of thrombosis

Cited by 17 publications

References 26 publications

Risk Factors of Cannula-associated Arterial Thrombosis following Extracorporeal Membrane Oxygenation support: A Retrospective Study

Risk Factors of Cannula-associated Arterial Thrombosis following Extracorporeal Membrane Oxygenation support: A Retrospective Study

Venous thromboembolic events in the setting of extracorporeal membrane oxygenation support in adults: A systematic review

ECMO Retrieval Program: What Have We Learned So Far

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