应用血小板聚集和标准试验评价静脉-动脉ECMO (VA)体外膜氧合的凝血功能:一个叙述回顾

IF 0.3 Q4 CRITICAL CARE MEDICINE Egyptian Journal of Critical Care Medicine Pub Date : 2018-12-01 DOI:10.1016/j.ejccm.2018.12.021
Poonam Malhotra Kapoor, Ameya Karanjkar, Vandana Bhardwaj
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引用次数: 6

摘要

体外膜氧合(ECMO)是一种成熟的治疗心力衰竭、肺衰竭或心肺衰竭的方法。为了抑制凝血级联的激活,抗凝是必要的。未分离肝素(UFH)通常用于达到治疗抗凝水平(ACT 180-220)。近年来,凝血粘弹性试验如血栓弹性成像(TEG)和ROTEM因其周期短、提供凝块组成和凝块强度的敏感信息,可用于评估和治疗ECMO患者的凝血功能而越来越多地被使用。使用ROTEM和阻抗聚集法进行POC凝血管理现在经常用于确定使用特定凝血因子浓缩物(如纤维蛋白原浓缩物和凝血酶原复合物浓缩物)的一线治疗。ECMO体外回路由于血小板的激活和消耗,导致血小板的定量和定性功能障碍。到目前为止,所有的研究都表明成人患者在体外氧合期间血小板聚集减少。血小板计数和血小板聚集之间有很强的联系。血小板黏附于ECMO回路所导致的血小板消耗状态均会增加患者ECMO出血的倾向。这篇叙述性的文献综述揭示了一些关于血小板聚集在ECMO中的作用的文献要点。ECMO是体外循环的一种形式,如果在ECMO中血小板聚集减少,那么这可能在发展治疗中发挥作用,这将抑制血小板并防止ECMO回路内的凝血激活,从而减少ECMO中的出血,提高死亡率。
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Evaluation of coagulopathy on veno-arterial ECMO (VA) extracorporeal membrane oxygenation using platelet aggregometry and standard tests: A narrative review

Extracorporeal membrane oxygenation (ECMO) is an established therapy for patients with cardiac failure, pulmonary failure or cardiopulmonary failure. To suppress the activation of the coagulation cascade, anticoagulation is necessary. Unfractionated heparin (UFH) is typically used for achieving the levels of therapeutic anticoagulation (ACT 180-220). Recently, viscoelastic tests of coagulation such as thrombo-elastrographyc (TEG) and ROTEM are increasingly used as they have shorter turnaround time and provide sensitive information about composition of clot, clot strength which can be used to assess and treat the coagulopathy on ECMO patients. POC coagulation management with ROTEM and impedance aggregometry is now frequently used to determine first-line therapy with specific coagulation factor concentrates such as fibrinogen concentrates and prothrombin complex concentrates.

Extracorporeal circuit of ECMO causes both quantitative and qualitative dysfunction of platelets due to activation and consumption. All studies so far has indicated reduced platelet aggregation in adult patients during ECMO. There is a strong association between platelet count and platelet aggregation. A consumptive platelet state due to platelet adhering to the ECMO circuit will all cause an increased tendency of patients bleeding ECMO. This narrative literature review brings to light some literature points on the role of platelet aggregometry during ECMO. ECMO is a form of cardiopulmonary bypass if platelet aggregation is reduced in ECMO, then this could play a role for the development therapies, which would inhibit platelets and prevent coagulation activation within the ECMO circuit, thus reducing bleeding in ECMO improving mortality.

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来源期刊
自引率
0.00%
发文量
5
审稿时长
42 weeks
期刊介绍: The Egyptian Journal of Critical Care Medicine is the official Journal of the Egyptian College of Critical Care Physicians, the most authoritative organization of Egyptian physicians involved in the multi-professional field of critical care medicine. The journal is intended to provide a peer-reviewed source for multidisciplinary coverage of general acute and intensive care medicine and its various subcategories including cardiac, pulmonary, neuro, renal as well as post-operative care. The journal is proud to have an international multi-professional editorial board in the broad field of critical care that will assist in publishing promising research and breakthrough reports that lead to better patients care in life threatening conditions, and bring the reader a quick access to the latest diagnostic and therapeutic approaches in monitoring and management of critically ill patients.
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