Current and future strategies to monitor and manage coagulation in ECMO patients

Thrombosis Journal

Review

Shaun D. Gregory¹  Josie Carberry²  Christoph E. Hagemeyer³  Saeedreza Zeibi Shirejini⁴  Aidan J. C. Burrell⁵  Zoe K. McQuilten⁶ 

[1] Cardiorespiratory Engineering and Technology Laboratory, Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, Australia;Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, Australia;NanoBiotechnology Laboratory, Central Clinical School, Australian Centre for Blood Diseases, Monash University, Melbourne, VIC, Australia;NanoBiotechnology Laboratory, Central Clinical School, Australian Centre for Blood Diseases, Monash University, Melbourne, VIC, Australia;Cardiorespiratory Engineering and Technology Laboratory, Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, Australia;School of Medicine, Nursing, and Health Sciences, Clayton and Intensive Care Unit, Monash University, Alfred Hospital, Melbourne, VIC, Australia;Department of Epidemiology and Preventative Medicine, School of Public Health, Monash University, Melbourne, VIC, Australia;Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, and Department of Clinical Haematology, Monash Health, Melbourne, VIC, Australia;

关键词: Anticoagulation;    Extracorporeal Membrane Oxygenation;    Monitoring Techniques;    Thrombosis;    Bleeding;    Respiratory Failure;    Heparin-Induced Thrombocytopenia (HIT);   

DOI  :  10.1186/s12959-023-00452-z

 received in 2022-09-23, accepted in 2023-01-18,  发布年份 2023

来源: Springer

【 摘 要 】

Extracorporeal membrane oxygenation (ECMO) can provide life-saving support for critically ill patients suffering severe respiratory and/or cardiac failure. However, thrombosis and bleeding remain common and complex problems to manage. Key causes of thrombosis in ECMO patients include blood contact to pro-thrombotic and non-physiological surfaces, as well as high shearing forces in the pump and membrane oxygenator. On the other hand, adverse effects of anticoagulant, thrombocytopenia, platelet dysfunction, acquired von Willebrand syndrome, and hyperfibrinolysis are all established as causes of bleeding. Finding safe and effective anticoagulants that balance thrombosis and bleeding risk remains challenging. This review highlights commonly used anticoagulants in ECMO, including their mechanism of action, monitoring methods, strengths and limitations. It further elaborates on existing anticoagulant monitoring strategies, indicating their target range, benefits and drawbacks. Finally, it introduces several highly novel approaches to real-time anticoagulation monitoring methods including sound, optical, fluorescent, and electrical measurement as well as their working principles and future directions for research.

【 授权许可】

CC BY   
© The Author(s) 2023

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