Skip to main content

Gerinnungsmanagement unter ECLS

  • Chapter
  • First Online:
Mechanische Unterstützung im akuten Kreislaufversagen

Zusammenfassung

Innerhalb der letzten 50 Jahre wurden auf dem Gebiet des extrakorporalen Life Support Systems (ECLS) vor allem in Bezug auf die verwendeten Materialien und der angewandten Techniken große Fortschritte erzielt. Nichtsdestotrotz stellt das Gerinnungsmanagement unter ECLS immer noch eine besondere medizinische Herausforderung dar. Durch die ECLS-Therapie wird das normalerweise fein ausbalancierte Gerinnungssystem aufgrund der großen Exposition mit gerinnungsaktivierenden Fremdkörperoberflächen innerhalb des ECLS-Umlaufs massiv gestört.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 74.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Literatur

  • (Anonym) (2017) ELSO Guideline for Cardiopulmonary Extracorporal Support Extracorporal Life Support OrganizationExtracorporal Life Support Organization. Version 1.4

    Google Scholar 

  • Abrams D et al (2018) Position paper for the organization of ECMO programs for cardiac failure in adults. Intensive Care Med 44(6):717–729

    Article  PubMed  Google Scholar 

  • Alexander DC et al (2010) Correlation of thromboelastography with standard tests of anticoagulation in paediatric patients receiving extracorporeal life support. Thromb Res 125(5):387–392

    Article  CAS  PubMed  Google Scholar 

  • Annich GM (2015) Extracorporeal life support: the precarious balance of hemostasis. J Thromb Haemost 13(Suppl 1):S336–S342

    Article  PubMed  Google Scholar 

  • Annich GM et al (2017) Thromboprophylaxis in extracorporeal circuits: current pharmacological strategies and future directions. Am J Cardiovasc Drugs 17(6):425–439

    Article  CAS  PubMed  Google Scholar 

  • Anonym (2014) The Extracorporeal Life Support Organization (ELSO), Ann Arbor, MI, USA, ELSO Anticoagulation Guidelines

    Google Scholar 

  • Anselmi A et al (2016) Safety of recombinant factor VIIa in patients under extracorporeal membrane oxygenation. Eur J Cardiothorac Surg 49(1):78–84

    Article  PubMed  Google Scholar 

  • Aranki SF et al (1993) Femoral veno-arterial extracorporeal life support with minimal or no heparin. Ann Thorac Surg 56(1):149–155

    Article  CAS  PubMed  Google Scholar 

  • Bain J et al (2017) Heparin induced thrombocytopenia with mechanical circulatory support devices: review of the literature and management considerations. J Thromb Thrombolysis 44(1):76–87

    Article  CAS  PubMed  Google Scholar 

  • Beckmann A et al (2011) Position article for the use of extracorporeal life support in adult patients. Eur J Cardiothorac Surg 40(3):676–680

    PubMed  Google Scholar 

  • Bennett M et al (2018) The Safe Addition of Nitric Oxide into the Sweep Gas of the Extracorporeal Circuit during Cardiopulmonary Bypass and Extracorporeal Life Support. J Extra Corpor Technol 50(4):260–264

    PubMed  PubMed Central  Google Scholar 

  • Bolliger D et al (2016) Point-of-care coagulation management algorithms during ECMO support: are we there yet? Minerva Anestesiol 82(9):1000–1009

    PubMed  Google Scholar 

  • Bonar R, Favaloro EJ (2017) Explaining and reducing the variation in inter-laboratory reported values for International Normalised Ratio. Thromb Res 150:22–29

    Article  CAS  PubMed  Google Scholar 

  • Broos K et al (2011) Platelets at work in primary hemostasis. Blood Rev 25(4):155–167

    Article  CAS  PubMed  Google Scholar 

  • Byrnes J et al (2011) Hemolysis during cardiac extracorporeal membrane oxygenation: a case-control comparison of roller pumps and centrifugal pumps in a pediatric population. ASAIO J 57(5):456–461

    Article  PubMed  Google Scholar 

  • Chan VH et al (2010) Novel paediatric anticoagulants: a review of the current literature. Blood Coagul Fibrinolysis 21(2):144–151

    Article  CAS  PubMed  Google Scholar 

  • Choi JH et al (2019) Heparin-induced thrombocytopenia during extracorporeal life support: incidence, management and outcomes. Ann Cardiothorac Surg 8(1):19–31

    Article  PubMed  PubMed Central  Google Scholar 

  • Coughlin MA, Bartlett RH (2015) Anticoagulation for Extracorporeal Life Support: Direct Thrombin Inhibitors and Heparin. ASAIO J 61(6):652–655

    Article  CAS  PubMed  Google Scholar 

  • Cuker A (2014) Clinical and laboratory diagnosis of heparin-induced thrombocytopenia: an integrated approach. Semin Thromb Hemost 40(1):106–114

    CAS  PubMed  Google Scholar 

  • Cuker A et al (2018) American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv 2(22):3360–3392

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Dickey LA et al (1994) Selective heparinization of the extracorporeal membrane oxygenation circuit using continuous infusions of protamine and heparin in a short-term pig model. Perfusion 9(5):327–333

    Article  CAS  PubMed  Google Scholar 

  • Diehl A, Gantner D (2018) Pump head thrombosis in extracorporeal membrane oxygenation (ECMO). Intensive Care Med 44(3):376–377

    Article  PubMed  Google Scholar 

  • Downard CD et al (2003) Impact of AMICAR on hemorrhagic complications of ECMO: a ten-year review. J Pediatr Surg 38(8):1212–1216

    Article  PubMed  Google Scholar 

  • Feindt P et al (2011) Use of extracorporeal circulation (ECC) outside the cardiac operating room: indications, requirements and recommendations for routine practice. Thorac Cardiovasc Surg 59(2):66–68

    Article  CAS  PubMed  Google Scholar 

  • Gorlinger K et al (2012) Coagulation management in patients undergoing mechanical circulatory support. Best Pract Res Clin Anaesthesiol 26(2):179–198

    Article  PubMed  Google Scholar 

  • Heilmann C et al (2012a) Acquired von Willebrand syndrome in patients with extracorporeal life support (ECLS). Intensive Care Med 38(1):62–68

    Article  PubMed  Google Scholar 

  • Heilmann C et al (2012b) Established markers of renal and hepatic failure are not appropriate to predict mortality in the acute stage before extracorporeal life support implantation. Eur J Cardiothorac Surg 42(1):135–141 discussion 141

    Article  PubMed  Google Scholar 

  • Jacobson J (2002) Nitric oxide: platelet protectant properties during cardiopulmonary bypass/ECMO. J Extra Corpor Technol 34(2):144–147

    PubMed  Google Scholar 

  • Kalbhenn J et al (2018) Acquired von Willebrand syndrome and impaired platelet function during venovenous extracorporeal membrane oxygenation: Rapid onset and fast recovery. J Heart Lung Transplant 37(8):985–991

    Article  PubMed  Google Scholar 

  • Karagiannidis C et al (2016) Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med 42(5):889–896

    Article  CAS  PubMed  Google Scholar 

  • Kim YS et al (2018) Use of argatroban for extracorporeal life support in patients with nonheparin-induced thrombocytopenia: Analysis of 10 consecutive patients. Medicine (Baltimore) 97(47):e13235

    Article  CAS  Google Scholar 

  • Kimmoun A et al (2018) Prevalence and outcome of heparin-induced thrombocytopenia diagnosed under veno-arterial extracorporeal membrane oxygenation: a retrospective nationwide study. Intensive Care Med 44(9):1460–1469

    Article  CAS  PubMed  Google Scholar 

  • Kulkarni T et al (2016) Extracorporeal membrane oxygenation in adults: a practical guide for internists. Cleve Clin J Med 83(5):373–384

    Article  PubMed  Google Scholar 

  • Kumar TK et al (2010) Extracorporeal membrane oxygenation in postcardiotomy patients: factors influencing outcome. J Thorac Cardiovasc Surg 140(2):330–336, e332

    Article  PubMed  Google Scholar 

  • Larsson M et al (2014) A factor XIIa inhibitory antibody provides thromboprotection in extracorporeal circulation without increasing bleeding risk. Sci Transl Med 6(222):222ra217

    Article  CAS  Google Scholar 

  • Le Gall A et al (2018) Veno-arterial-ECMO in the intensive care unit: From technical aspects to clinical practice. Anaesth Crit Care Pain Med 37(3):259–268

    Article  PubMed  Google Scholar 

  • Levrat A et al (2008) Evaluation of rotation thrombelastography for the diagnosis of hyperfibrinolysis in trauma patients. Br J Anaesth 100(6):792–797

    Article  CAS  PubMed  Google Scholar 

  • Levy JH et al (2016) Antithrombin: anti-inflammatory properties and clinical applications. Thromb Haemost 115(4):712–728

    Article  PubMed  Google Scholar 

  • Major TC et al (2014) Development and hemocompatibility testing of nitric oxide releasing polymers using a rabbit model of thrombogenicity. J Biomater Appl 29(4):479–501

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Makdisi G, Wang IW (2015) Extra Corporeal Membrane Oxygenation (ECMO) review of a lifesaving technology. J Thorac Dis 7(7):E166–E176

    PubMed  PubMed Central  Google Scholar 

  • Mazzeffi M, Tanaka K (2016) Platelets and ECMO: should we worry about count, function, or both? Intensive Care Med 42(7):1199–1200

    Article  PubMed  Google Scholar 

  • Meuwese CL et al (2018) Extracorporeal life support in cardiogenic shock: indications and management in current practice. Neth Heart J 26(2):58–66

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Niebler RA et al (2010) Activated recombinant factor VII for refractory bleeding during extracorporeal membrane oxygenation. Pediatr Crit Care Med 11(1):98–102

    Article  PubMed  Google Scholar 

  • Novak M et al (2011) Effect of rivaroxaban, in contrast to heparin, is similar in neonatal and adult plasma. Blood Coagul Fibrinolysis 22(7):588–592

    Article  CAS  PubMed  Google Scholar 

  • Palta S et al (2014) Overview of the coagulation system. Indian J Anaesth 58(5):515–523

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Peek GJ et al (2002) Early experience with a polymethyl pentene oxygenator for adult extracorporeal life support. ASAIO J 48(5):480–482

    Article  CAS  PubMed  Google Scholar 

  • Pichler P et al (2015) Use of ECMO in adult patients with cardiogenic shock: a position paper of the Austrian Society of Cardiology. Med Klin Intensivmed Notfmed 110(6):407–420

    Article  PubMed  Google Scholar 

  • Pishko AM, Cuker A (2017) Heparin-Induced Thrombocytopenia in Cardiac Surgery Patients. Semin Thromb Hemost 43(7):691–698

    Article  PubMed  PubMed Central  Google Scholar 

  • Pratt CW, Church FC (1991) Antithrombin: structure and function. Semin Hematol 28(1):3–9

    CAS  PubMed  Google Scholar 

  • Repesse X et al (2013) Recombinant factor VIIa for uncontrollable bleeding in patients with extracorporeal membrane oxygenation: report on 15 cases and literature review. Crit Care 17(2):R55

    Article  PubMed  PubMed Central  Google Scholar 

  • Roberts TR et al (2019) Thromboelastography on-the-go: evaluation of the TEG 6s device during ground and high-altitude aeromedical evacuation with extracorporeal life support. J Trauma Acute Care Surg 87(1S):119–127

    Article  Google Scholar 

  • Saifee, NH et al (2019) Monitoring hemostasis during extracorporeal life support. ASAIO J

    Google Scholar 

  • Smith A et al (2013) Red blood cell transfusion volume and mortality among patients receiving extracorporeal membrane oxygenation. Perfusion 28(1):54–60

    Article  PubMed  Google Scholar 

  • Thomas J et al (2018) Bleeding and thrombotic complications in the use of extracorporeal membrane oxygenation. Semin Thromb Hemost 44(1):20–29

    Article  PubMed  Google Scholar 

  • Tory HO et al (2010) Outcomes of children treated for Lyme arthritis: results of a large pediatric cohort. J Rheumatol 37(5):1049–1055

    Article  PubMed  Google Scholar 

  • van der Staak FH et al (1997) Surgical repair of congenital diaphragmatic hernia during extracorporeal membrane oxygenation: hemorrhagic complications and the effect of tranexamic acid. J Pediatr Surg 32(4):594–599

    Article  PubMed  Google Scholar 

  • Weber C et al (2018) Left ventricular thrombus formation in patients undergoing femoral veno-arterial extracorporeal membrane oxygenation. Perfusion 33(4):283–288

    Article  PubMed  Google Scholar 

  • Wikkelso A et al (2017) Thromboelastography (TEG) or rotational thromboelastometry (ROTEM) to monitor haemostatic treatment in bleeding patients: a systematic review with meta-analysis and trial sequential analysis. Anaesthesia 72(4):519–531

    Article  CAS  PubMed  Google Scholar 

  • Zonies D, Merkel M (2016) Advanced extracorporeal therapy in Trauma. Curr Opin Crit Care 22(6):578–583

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Guido Michels .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Michels, G., Sabashnikov, A., Merkle, J. (2020). Gerinnungsmanagement unter ECLS. In: Boeken, U., Assmann, A., Klotz, S., Born, F., Rieth, A., Schmid, C. (eds) Mechanische Unterstützung im akuten Kreislaufversagen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-59901-3_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-59901-3_3

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-59900-6

  • Online ISBN: 978-3-662-59901-3

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics