VV extracorporeal life support for the Third Millennium: will we need anticoagulation?

Eytan, Danny; Bitterman, Yuval; Annich, Gail M.

doi:10.21037/jtd.2017.11.89

Cited by 6 publications

(9 citation statements)

References 79 publications

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“…New generations of extracorporeal circuits are also being developed, including surface modifications with improved biocompatibility, miniaturized circuit or circuits with self-regulated flow-demand loops ( 35 – 37 ). Novel therapies for multimodal pulmonary hypertension management have the potential to alter the natural history of diseases in which ECMO may be considered ( 38 , 39 ).…”

Section: Methodological Challenges In Pediatric Ecmo Researchmentioning

confidence: 99%

Pediatric ECMO Research: The Case for Collaboration

2018

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The use of extracorporeal membrane oxygenation (ECMO) in the pediatric age has increased considerably in the last decade, as has the complexity of cases and the variety of indications outside of the neonatal age. However, no randomized controlled trials have been attempted to date to test ECMO as an intervention in non-neonatal pediatric patients with critical illness. In this review, we provide a brief overview of the history of clinical research in pediatric ECMO and discuss methodological challenges including heterogeneity of ages and diagnoses in the pediatric ECMO population, rapid advances in technology and clinical practice related to ECMO, feasibility of enrolling critically ill children on ECMO in clinical research studies, and variability in ECMO management across institutions and countries. Lastly, we discuss opportunities and existing infrastructure for future multicenter, multi-network research collaborations for pediatric ECMO studies.

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Section: Methodological Challenges In Pediatric Ecmo Researchmentioning

confidence: 99%

Pediatric ECMO Research: The Case for Collaboration

2018

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“…Surface modifications broadly classified as surface passivation, biomimetic, and endothelialization are techniques used to mitigate the bio‐incompatibility of ECMO circuitry and may facilitate anticoagulant‐free ECMO 40,41 . A large, systematic review evaluating the effect of heparin‐bonded circuits (HBC) on multiple clinical outcomes determined that HBCs did significantly reduce the incidence of blood transfusion, duration of ventilation, and ICU length of stay compared to non‐HBCs 42 .…”

Section: Continuous Extracorporeal Circulatory Devicesmentioning

confidence: 99%

Anticoagulation strategies in extracorporeal circulatory devices in adult populations

Kato

Oakes

Kim

et al. 2020

European J of Haematology

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Extracorporeal circulatory devices such as hemodialysis and extracorporeal membrane oxygenation can be lifesaving; however, they are also prone to pathologic events including device failure, venous and arterial thrombosis, hemorrhage, and an accelerated risk for atherosclerotic disease due to interactions between blood components and device surfaces of varying biocompatibility. While extracorporeal devices may be used acutely for limited periods of time (eg, extracorporeal membrane oxygenation, continuous venovenous hemofiltration, therapeutic apheresis), some patients require chronic use of these technologies (eg, intermittent hemodialysis and left ventricular assist devices). Given the substantial thrombotic risks associated with extracorporeal devices, multiple antiplatelet and anticoagulation strategies—including unfractionated heparin, low‐molecular‐weight heparin, citrate, direct thrombin inhibitors, and direct oral anticoagulants, have been used to mitigate the thrombotic milieu within the patient and device. In the following manuscript, we outline the current data on anticoagulation strategies for commonly used extracorporeal circulatory devices, highlighting the potential benefits and complications involved with each.

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“…We can classify the different surface modifications into three major groups: biomimetic surfaces [heparin, nitric oxide (NO), and DTI]; biopassive surfaces [phosphorylcholine (PPC), albumin, and poly-2-methoxyethylacrylate (PMEA)]; and endothelialization of blood contacting surfaces ( 4 , 12 ). A combination of surface passivation and biomimetic surfaces are already in use in clinical practice with heparin coating ( 13 ) and zwitterionic PPC polymers ( 14 ).…”

Section: Surface Modificationsmentioning

confidence: 99%

“…Endothelialization of the surface can be achieved by two different methods: (I) in vitro pre-endothelialization of the ECC, or (II) endothelial progenitor cells (EPCs)-based in vivo induced self-endothelialization ( 4 , 73 , 75 , 76 ).…”

Section: Endothelializationmentioning

confidence: 99%

“…Despite these advantages it poses a range of complications that increase morbidity and mortality in the ECLS population, including the risk of developing heparin-induced thrombocytopenia (HIT). New trends in ECLS include the use of direct thrombin inhibitor (DTI) agents for systemic anticoagulation ( 3 , 4 ); and surface modifications that aim to overcome the blood-biomaterial surface interaction by modifying the hydrophilicity or hydrophobicity of the polymer surface; and coating the circuit with substances that will mimic the endothelium or anti-thrombotic agents ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

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Novel Surfaces in Extracorporeal Membrane Oxygenation Circuits

2018

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The balance between systemic anticoagulation and clotting is challenging. In normal hemostasis, the endothelium regulates the balance between anticoagulant and prothrombotic systems. It becomes particularly more challenging to maintain this physiologic hemostasis when we are faced with extracorporeal life support therapies, where blood is continuously in contact with a foreign extracorporeal circuit surface predisposing a prothrombotic state. The blood-surface interaction during extracorporeal life support therapies requires the use of systemic anticoagulation to decrease the risk of clotting. Unfractionated heparin is the most common anticoagulant agent widely used in this setting. New trends include the use of direct thrombin inhibitor agents for systemic anticoagulation; and surface modifications that aim to overcome the blood-biomaterial surface interaction by modifying the hydrophilicity or hydrophobicity of the polymer surface; and coating the circuit with substances that will mimic the endothelium or anti-thrombotic agents. To improve hemocompatibility in an extracorporeal circuit, replication of the anti-thrombotic and anti-inflammatory properties of the endothelium is ideal. Surface modifications can be classified into three major groups: biomimetic surfaces (heparin, nitric oxide, and direct thrombin inhibitors); biopassive surfaces [phosphorylcholine, albumin, and poly- 2-methoxyethylacrylate]; and endothelialization of blood contacting surface. The focus of this paper will be to review both present and future novel surface modifications that can obviate the need for systemic anticoagulation during extracorporeal life support therapies.

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VV extracorporeal life support for the Third Millennium: will we need anticoagulation?

Cited by 6 publications

References 79 publications

Pediatric ECMO Research: The Case for Collaboration

Pediatric ECMO Research: The Case for Collaboration

Anticoagulation strategies in extracorporeal circulatory devices in adult populations

Novel Surfaces in Extracorporeal Membrane Oxygenation Circuits

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