Original articleAdult cardiacBleeding, Transfusion, and Mortality on Extracorporeal Life Support: ECLS Working Group on Thrombosis and Hemostasis
Section snippets
Subjects
The Institutional Review Board at the University of Maryland, Baltimore, approved the study. Data were collected using electronic medical records, the institutional Extracorporeal Life Support Organization (ELSO) database, and scanned hospital records. All adult patients who had ECLS between March 1, 2010, and August 15, 2013, were included.
Demographic Data and Comorbidities
For all subjects we recorded age, sex, diabetes mellitus, hypertension, baseline right ventricular function (defined as none, mild, moderate, or severe
Patient Characteristics
Patient characteristics are listed in Table 1. Of the 132 patients, 40.9% required VA ECLS, 48.5% required VV ECLS, and 10.6% required both modalities. The most common diagnosis was adult respiratory distress syndrome, and the median number of ECLS days for the cohort was 7. Patients who had a serious bleeding event during ECLS were older (p = 0.004). They were also more likely to be male, have chronic hypertension, have postcardiotomy shock, have central cannulation, and have VA ECLS compared
Comment
Coagulation management during ECLS is challenging because patients require systemic anticoagulation therapy to prevent thrombosis but it puts them at risk for serious bleeding events. Currently, anticoagulation therapy protocols for ECLS are highly variable among ECLS centers [15]. There is also a large amount of variability in transfusion practice and coagulation management among individual patients at a particular center [16]. In addition to systemic anticoagulation therapy, multifactorial
References (23)
- et al.
Outcome in patients who require venoarterial extracorporeal membrane oxygenation support after cardiac surgery
J Cardiothorac Vasc Anesth
(2010) - et al.
Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients
Ann Thorac Surg
(2014) - et al.
A meta-analysis of complications and mortality of extracorporeal membrane oxygenation
Crit Care Resusc
(2013) - et al.
A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey
Chest
(2010) - et al.
Resource use trends in extracorporeal membrane oxgyenation: an analysis of the nationwide inpatient sample 1998-2009
J Thorac Cardiovasc Surg
(2014) - et al.
Predicting mortality risk in patients undergoing venovenous ECMO for ARDS due to influenza A (H1N1) pneumonia: the ECMOnet score
Intensive Care Med
(2013) - et al.
The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome
Intensive Care Med
(2013) - et al.
Extracorporeal Life Support Organization registry report 2012
ASAIO J
(2013) - et al.
Postcardiotomy mechanical support: risk factors and outcomes
Ann Thorac Surg
(2001) - et al.
Extracorporeal membrane oxygenation in the adult: a review of anticoagulation monitoring and transfusion
Anesth Analg
(2014)
The mechanisms of platelet dysfunction during extracorporeal membrane oxygenation
Crit Care Med
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