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Bleeding Associated with ECMO

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Management of Bleeding Patients

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Abstract

Extracorporeal membrane oxygenation (ECMO) has been used for approximately 40 years to support the lung and heart; however, bleeding remains a serious complication during ECMO. The known etiology of bleeding includes heparin effect or overdose, coagulopathy, thrombocytopenia, platelet dysfunction, acquired von Willebrand syndrome, and hyperfibrinolysis. Bleeding sites may be cannula insertion sites, the lung, gastrointestinal tract, mouth, nose, thoracic cavity, abdominal cavity, and brain. Among them massive bleeding in the brain can be immediately fatal due to anticoagulation. Pulmonary hemorrhage may cause irreversible lung damage. Management should not be delayed in order to prevent fatal bleeding. However, the balance between bleeding and thrombosis is extremely delicate in the setting of ECMO. Experts in hemostasis should be a part of ECMO team and always available for immediate management.

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References

  1. Bartlett RH, Gazzaniga AB, Jefferies MR, Huxtable RF, Haiduc NJ, Fong SW. Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy. Trans Am Soc Artif Intern Organs. 1976;22:80–93.

    CAS  PubMed  Google Scholar 

  2. Khaja W, Bilen O, Lukner R, Edwards R, Teruya J. Evaluation of heparin assay for coagulation management in newborns on ECMO. Am J Clin Pathol. 2010;134:950–4.

    Article  CAS  PubMed  Google Scholar 

  3. O'Meara LC, Alten JA, Goldberg KG, Timpa JG, Phillips J, Laney D, Borasino S. Anti-xa directed protocol for anticoagulation management in children supported with extracorporeal membrane oxygenation. ASAIO J. 2015;61:339–44. doi:10.1097/MAT.0000000000000204.

    Article  PubMed  Google Scholar 

  4. Yie K, Chon SD, Na CY. Activated clotting time test alone is inadequate to optimize therapeutic heparin dosage adjustment during post-cardiopulmonary resuscitational extracorporeal membrane oxygenation (e-CPR). Perfusion. 2015;pii:0267659115604710.

    Google Scholar 

  5. Brodin E, Svenesson B, Paulssen RH, Nordoy A, Hansen JB. Intravascular release and urinary excretion of tissue factor pathway inhibitor during heparin treatment. J Lab Clin Med. 2004;144:246–53.

    Article  CAS  PubMed  Google Scholar 

  6. Winckers K, ten Cate H, Hackeng TM. The role of tissue factor pathway inhibitor in atherosclerosis and arterial thrombosis. Blood Rev. 2013;27:119–32. doi:10.1016/j.blre.2013.03.001.

    Article  CAS  PubMed  Google Scholar 

  7. Ariens RA, Alberio G, Moia M, Mannucci PM. Low levels of heparin-releasable tissue factor pathway inhibitor in young patients with thrombosis. Thromb Haemost. 1999;81:203–7.

    CAS  PubMed  Google Scholar 

  8. Vincent LM, Tran S, Livaja R, Bensend TA, Milewicz DM, Dahlbäck B. Coagulation factor V(A2440G) causes east Texas bleeding disorder via TFPIα. J Clin Invest. 2013;123(9):3777–87. doi:10.1172/JCI69091.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Cunha ML, Bakhtiari K, Peter J, Marquart JA, Meijers JC, Middeldorp S. A novel mutation in the F5 gene (factor V Amsterdam) associated with bleeding independent of factor V procoagulant function. Blood. 2015;125:1822–5. doi:10.1182/blood-2014-08-592733.

    Article  CAS  PubMed  Google Scholar 

  10. Newall F, Johnston L, Summerhayes R, Lane G, Cranswick N, Monagle P, et al. Novel interactions between UFH and TFPI in children. Br J Haematol. 2010;151:376–80. doi:10.1111/j.1365-2141.2010.08373.x.

    Article  PubMed  Google Scholar 

  11. Hundalani SG, Nguyen KT, Soundar E, Kostousov V, Bomgaars L, Moise A, et al. Age-based difference in activation markers of coagulation and fibrinolysis in extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2014;15:e198–205. doi:10.1097/PCC.0000000000000107.

    Article  PubMed  Google Scholar 

  12. Kalbhenn J, Wittau N, Schmutz A, Zieger B, Schmidt R. Identification of acquired coagulation disorders and effects of target-controlled coagulation factor substitution on the incidence and severity of spontaneous intracranial bleeding during veno-venous ECMO therapy. Perfusion. 2015;pii:0267659115579714.

    Google Scholar 

  13. Robinson TM, Kickler TS, Walker LK, Ness P, Bell W. Effect of extracorporeal membrane oxygenation on platelets in newborns. Crit Care Med. 1993;21:1029–34.

    Article  CAS  PubMed  Google Scholar 

  14. Downard CD, Betit P, Chang RW, Garza JJ, Arnold JH, Wilson JM. Impact of AMICAR on hemorrhagic complications of ECMO: a ten-year review. J Pediatr Surg. 2003;38:1212–6.

    Article  PubMed  Google Scholar 

  15. Kalbhenn J, Schmidt R, Nakamura L, Schelling J, Rosenfelder S, Zieger B. Early diagnosis of acquired von Willebrand Syndrome (AVWS) is elementary for clinical practice in patients treated with ECMO therapy. J Atheroscler Thromb. 2015;22:265–71. doi:10.5551/jat.27268.

    Article  CAS  PubMed  Google Scholar 

  16. Pasala S, Fiser RT, Stine KC, Swearingen CJ, Prodhan P. von Willebrand factor multimers in pediatric extracorporeal membrane oxygenation support. ASAIO J. 2014;60:419–23. doi:10.1097/MAT.0000000000000084.

    Article  CAS  PubMed  Google Scholar 

  17. Heilmann C, Geisen U, Beyersdorf F, Nakamura L, Benk C, Trummer G, et al. Acquired von Willebrand syndrome in patients with extracorporeal life support (ECLS). Intensive Care Med. 2012;38:62–8. doi:10.1007/s00134-011-2370-6.

    Article  PubMed  Google Scholar 

  18. Tiede A, Priesack J, Werwitzke S, Bohlmann K, Oortwijn B, Lenting P, et al. Diagnostic workup of patients with acquired von Willebrand syndrome: a retrospective single-centre cohort study. J Thromb Haemost. 2008;6:569–76. doi:10.1111/j.1538-7836.2008.02909.x.

    Article  CAS  PubMed  Google Scholar 

  19. Da Q, Teruya M, Guchhit P, Teruya J, Olson J, Cruz M. Free hemoglobin modulates von Willebrand factor-mediated platelet adhesion in vitro: implications on circulatory devices. Blood. 2015;126:2338–41.

    Article  CAS  PubMed  Google Scholar 

  20. Zhou Z, Han H, Cruz MA, et al. Haemoglobin blocks von Willebrand factor proteolysis by ADAMTS-13: a mechanism associated with sickle cell disease. Thromb Haemost. 2009;101(6):1070–7.

    CAS  PubMed  Google Scholar 

  21. Bembea MM, Annich G, Rycus P, Oldenburg G, Berkowitz I, Pronovost P. Variability in anticoagulation management of patients on extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2013;14:e77–84.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Departments of Pathology & Immunology, Pediatrics, and Medicine, Baylor College of Medicine, Division of Transfusion Medicine & Coagulation, Texas Children’s Hospital, 6621 Fannin St., Suite WB1100, Houston, TX, 77030, USA

    Jun Teruya M.D., D.Sc., F.C.A.P., F.A.S.C.P

  2. ECMO Services, Texas Children’s Hospital, 6621 Fannin St., Houston, TX, 77030, USA

    Cole Burgman C.C.P.

Authors
  1. Jun Teruya M.D., D.Sc., F.C.A.P., F.A.S.C.P
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  2. Cole Burgman C.C.P.
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Correspondence to Jun Teruya M.D., D.Sc., F.C.A.P., F.A.S.C.P .

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Editors and Affiliations

  1. Departments of Pathology & Immunology, Pediatrics, and Medicine, Baylor College of Medicine Division of Transfusion Medicine & Coagulation Texas Children’s Hospital, Houston, Texas, USA

    Jun Teruya

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© 2016 Springer International Publishing Switzerland

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Teruya, J., Burgman, C. (2016). Bleeding Associated with ECMO. In: Teruya, J. (eds) Management of Bleeding Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-30726-8_27

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  • DOI: https://doi.org/10.1007/978-3-319-30726-8_27

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-30724-4

  • Online ISBN: 978-3-319-30726-8

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