Thoracotomy in adults while on ECMO is associated with uncontrollable bleeding

Marasco, Silvana; Preovolos, Arthur; Lim, Kiat; Salamonsen, Robert F.

doi:10.1177/0267659106074789

Cited by 26 publications

(22 citation statements)

References 19 publications

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“…However, these techniques are associated with an increased complication rate. 7,8 Levosimendan is a pyridazinone-dinitrile derivative belonging to a new class of inotropic drugs, the Ca 2ϩ sensitizers. It presents a positive inotropic effect by sensitizing cardiac troponin-C to calcium during systole, thus increasing cardiac performance without increasing myocardial oxygen consumption and with a weak arrhythmogenic effect.…”

mentioning

confidence: 99%

Levosimendan: A New Therapeutic Option in the Treatment of Primary Graft Dysfunction After Heart Transplantation

Weis

Beiras-Fernández

Kaczmarek

et al. 2009

The Journal of Heart and Lung Transplantation

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mentioning

confidence: 99%

Levosimendan: A New Therapeutic Option in the Treatment of Primary Graft Dysfunction After Heart Transplantation

Weis

Beiras-Fernández

Kaczmarek

et al. 2009

The Journal of Heart and Lung Transplantation

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“…Bleeding is a common complication of ECMO and a hallmark of poor outcome, either due to withdraw of ECMO support due to uncontrolled bleeding or due to a hemorrhagic complication [5]. Often bleeding is disproportionate to the degree of coagulopathy or thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

“…The thromboembolic risks are lower with VV ECMO than with veno-arterial (VA) ECMO because any thrombus "thrown" from the circuit during VV ECMO enters the right atrium instead of the aorta (i.e., brain, coronaries). Still, typically a heparin bolus is given intravenously at the time of ECMO cannulation and then an infusion is started once postoperative bleeding has been controlled, aiming for an aPTT of 50 -80 s or ACT 160 -220 [5]. An aim to keep platelets greater than 80 × 109/L is acceptable [6].…”

Section: Discussionmentioning

confidence: 99%

Veno-Venous Extracorporeal Membrane Oxygenation: Anesthetic Management for Massive Intracranial Hemorrhage in H1N1 Infection

Kraus¹,

Weis²,

Alwardt³

et al. 2015

OJAnes

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Background: Extracorporeal membrane oxygenator (ECMO) use is dramatically increasing in recent years. This case report describes a patient on veno-venous (VV) ECMO for H1N1 who underwent emergent craniotomy twice for intracranial hemorrhage. Case presentation: A 38-year-old male presented to a community hospital for worsening shortness of breath. He had experienced cough, malaise and fatigue for two weeks prior to presentation. On arrival, his arterial oxygen saturation was 64%. He was placed on oxygen via non-rebreather mask and started on Tamiflu plus antibiotics. He was intubated for worsening respiratory failure. Despite maximal ventilator settings, the arterial oxygen saturation was approximately 90%. He was placed in the prone position and nitric oxide was initiated. Severe acute respiratory distress syndrome (ARDS) secondary to influenza was diagnosed by viral PCR, clinical presentation, and diagnostic imaging. Within 24 hours of his intubation, a decision was made to initiate veno-venous (V-V) ECMO for respiratory support. Five days following the initiation of ECMO, asymmetric pupils and a nonreactive right pupil were noted. A massive right frontal intraparenchymal hemorrhage with midline shift and downward uncal herniation was found on computed tomography (CT). A decision was made to surgically intervene. He was taken to the operating room for immediate right frontal craniotomy and clot evacuation under general anesthesia. Conclusion: With the dramatic increase in ECMO use, anesthesiologists are encountering patients on ECMO in the operating room with more frequency. When the situation does arise, it is imperative that the anesthesiologist is knowledgeable about ECMO and how to appropriately administer anesthesia for these critically ill patients. Challenges M. Kraus et al. 252 confronting the anesthesiologist with ECMO patients include managing bleeding or coagulopathy, ventilation and oxygenation, volume status, transporting and positioning these patients, and altered pharmacokinetics of anesthetic drugs.

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“…26 Intracranial bleeding (1-11%), especially in neonates; gastrointestinal haemorrhage (1-4%); and pulmonary haemorrhage (4-8%) may also occur. 27 All organ systems can be affected by hypoxia and hypoperfusion before and during extracorporeal life support.…”

Section: Cardiopulmonary Resuscitationmentioning

confidence: 99%