Circuit change during extracorporeal membrane oxygenation: single-center retrospective study of 48 changes
Abstract Background Bleeding and thrombosis induce major morbidity and mortality in patients under extracorporeal membrane oxygenator (ECMO). Circuit changes can be performed for oxygenation membrane thrombosis but are not recommended for bleeding under ECMO. The objective of this study was to evalu...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-023-04503-9 |
| _version_ | 1797811464306688000 |
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| author | Thibaut Genty Stanislas Burguburu Audrey Imbert Calypso Roman Wirth Camille Jacques Thès François Stéphan |
| author_facet | Thibaut Genty Stanislas Burguburu Audrey Imbert Calypso Roman Wirth Camille Jacques Thès François Stéphan |
| author_sort | Thibaut Genty |
| collection | DOAJ |
| description | Abstract Background Bleeding and thrombosis induce major morbidity and mortality in patients under extracorporeal membrane oxygenator (ECMO). Circuit changes can be performed for oxygenation membrane thrombosis but are not recommended for bleeding under ECMO. The objective of this study was to evaluate the course of clinical, laboratory, and transfusion parameters before and after ECMO circuit changes warranted by bleeding or thrombosis. Methods In this single-center, retrospective, cohort study, clinical parameters (bleeding syndrome, hemostatic procedures, oxygenation parameters, transfusion) and laboratory parameters (platelet count, hemoglobin, fibrinogen, PaO2) were collected over the seven days surrounding the circuit change. Results In the 274 patients on ECMO from January 2017 to August 2020, 48 circuit changes were performed in 44 patients, including 32 for bleeding and 16 for thrombosis. Mortality was similar in the patients with vs. without changes (21/44, 48% vs. 100/230, 43%) and in those with bleeding vs. thrombosis (12/28, 43% vs. 9/16, 56%, P = 0.39). In patients with bleeding, numbers of bleeding events, hemostatic procedures, and red blood cell transfusions were significantly higher before vs. after the change (P < 0.001); the platelet counts and fibrinogen levels decreased progressively before and increased significantly after the change. In patients with thrombosis, numbers of bleeding events and red blood cell transfusions did not change after membrane change. No significant differences were demonstrated between oxygenation parameters (ventilator FiO2, ECMO FiO2, and PaO2) and ECMO flow before vs. after the change. Conclusions In patients with severe and persistent bleeding, changing the ECMO circuit decreased clinical bleeding and red blood cell transfusion needs and increased platelets and fibrinogen levels. Oxygenation parameters did not change significantly in the group with thrombosis. |
| first_indexed | 2024-03-13T07:22:51Z |
| format | Article |
| id | doaj.art-0640db056e0142f7a15e7ff4c677b8d7 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-03-13T07:22:51Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-0640db056e0142f7a15e7ff4c677b8d72023-06-04T11:30:11ZengBMCCritical Care1364-85352023-06-012711610.1186/s13054-023-04503-9Circuit change during extracorporeal membrane oxygenation: single-center retrospective study of 48 changesThibaut Genty0Stanislas Burguburu1Audrey Imbert2Calypso Roman3Wirth Camille4Jacques Thès5François Stéphan6Cardiothoracic Intensive Care Unit, Hôpital Marie LannelongueGroupe Hospitalier Paris Saint JosephCardiothoracic Intensive Care Unit, Hôpital Marie LannelongueGroupe Hospitalier Paris Saint JosephCardiothoracic Intensive Care Unit, Hôpital Marie LannelongueGroupe Hospitalier Paris Saint JosephCardiothoracic Intensive Care Unit, Hôpital Marie LannelongueGroupe Hospitalier Paris Saint JosephCardiothoracic Intensive Care Unit, Hôpital Marie LannelongueGroupe Hospitalier Paris Saint JosephDepartment of Anesthesiology, Extracorporeal Circulation Referral Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint JosephCardiothoracic Intensive Care Unit, Hôpital Marie LannelongueGroupe Hospitalier Paris Saint JosephAbstract Background Bleeding and thrombosis induce major morbidity and mortality in patients under extracorporeal membrane oxygenator (ECMO). Circuit changes can be performed for oxygenation membrane thrombosis but are not recommended for bleeding under ECMO. The objective of this study was to evaluate the course of clinical, laboratory, and transfusion parameters before and after ECMO circuit changes warranted by bleeding or thrombosis. Methods In this single-center, retrospective, cohort study, clinical parameters (bleeding syndrome, hemostatic procedures, oxygenation parameters, transfusion) and laboratory parameters (platelet count, hemoglobin, fibrinogen, PaO2) were collected over the seven days surrounding the circuit change. Results In the 274 patients on ECMO from January 2017 to August 2020, 48 circuit changes were performed in 44 patients, including 32 for bleeding and 16 for thrombosis. Mortality was similar in the patients with vs. without changes (21/44, 48% vs. 100/230, 43%) and in those with bleeding vs. thrombosis (12/28, 43% vs. 9/16, 56%, P = 0.39). In patients with bleeding, numbers of bleeding events, hemostatic procedures, and red blood cell transfusions were significantly higher before vs. after the change (P < 0.001); the platelet counts and fibrinogen levels decreased progressively before and increased significantly after the change. In patients with thrombosis, numbers of bleeding events and red blood cell transfusions did not change after membrane change. No significant differences were demonstrated between oxygenation parameters (ventilator FiO2, ECMO FiO2, and PaO2) and ECMO flow before vs. after the change. Conclusions In patients with severe and persistent bleeding, changing the ECMO circuit decreased clinical bleeding and red blood cell transfusion needs and increased platelets and fibrinogen levels. Oxygenation parameters did not change significantly in the group with thrombosis.https://doi.org/10.1186/s13054-023-04503-9ECMOOxygenator changeBleeding complicationOxygenator thrombosisTransfusion |
| spellingShingle | Thibaut Genty Stanislas Burguburu Audrey Imbert Calypso Roman Wirth Camille Jacques Thès François Stéphan Circuit change during extracorporeal membrane oxygenation: single-center retrospective study of 48 changes Critical Care ECMO Oxygenator change Bleeding complication Oxygenator thrombosis Transfusion |
| title | Circuit change during extracorporeal membrane oxygenation: single-center retrospective study of 48 changes |
| title_full | Circuit change during extracorporeal membrane oxygenation: single-center retrospective study of 48 changes |
| title_fullStr | Circuit change during extracorporeal membrane oxygenation: single-center retrospective study of 48 changes |
| title_full_unstemmed | Circuit change during extracorporeal membrane oxygenation: single-center retrospective study of 48 changes |
| title_short | Circuit change during extracorporeal membrane oxygenation: single-center retrospective study of 48 changes |
| title_sort | circuit change during extracorporeal membrane oxygenation single center retrospective study of 48 changes |
| topic | ECMO Oxygenator change Bleeding complication Oxygenator thrombosis Transfusion |
| url | https://doi.org/10.1186/s13054-023-04503-9 |
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