Clinical and pathophysiologic aspects of ECMO-associated hemorrhagic complications

• DOI: 10.1371/journal.pone.0240117
• Publication Date: 2020-10-13T13:42:34Z
• Authors: Konstantin A. Pop...; Sergey A. Bakharev; Kirill V. Kiselev; Alexander S. Samo...; Nikolay M. Kruglykov; Sergey A. Abudeev; Sergey V. Zhuravel; Aslan K. Shabanov; Thomas Mueller; Stephan A. Mayer; Sergey S. Petrikov
• Keywords: Thromboelastometry; Pathophysiology

Extracorporeal membrane oxygenation (ECMO) is increasingly used to treat severe cases of acute respiratory or cardiac failure. Hemorrhagic complications represent one the most common during ECMO, and can be life threatening. The purpose this study was elucidate pathophysiological mechanisms ECMO-associated hemorrhagic their impact on standard viscoelastic coagulation tests. cohort included 27 patients treated with VV-ECMO VA-ECMO. Hemostasis evaluated using tests parameters investigated rotational thromboelastometry. Anticoagulation were analyzed for up seven days depending ECMO duration. developed in 16 (59%) patients. There 102 discrete episodes among 116 24-hour-intervals, which 27% considered clinically significant. highest number hemorrhages occurred 2nd 3rd day treatment. Respiratory tract bleeding complication, occurring 62% 24-hour intervals. All 24-hours-intervals divided into two groups: "with bleeding" "without bleeding". probability hemorrhage significantly associated abnormalities four parameters: increased international normalized ratio (INR, sensitivity 71%, specificity 94%), prothrombin time (PT, 90%, 72%), decreased intrinsic pathway maximal clot firmness (MCFin, 76%, 89%), extrinsic formation (CFTex, 77%, 87%). In conclusions, early are related traditional novel abnormalities: PT/INR elevation, reduced maximum due dysfunction (MCFin), prolonged (CFTex). When managing hemostasis derangements PT/INR, MCFin CFTex should focused on.