Esper S A, Welsby I J, Subramaniam K, John Wallisch W, Levy J H, Waters J H, Triulzi D J, Hayanga J W A, Schears G J
Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Anesthesiology, Duke University, Durham, NC, USA.
Vox Sang. 2017 Jul;112(5):443-452. doi: 10.1111/vox.12514. Epub 2017 May 3.
Extracorporeal membrane oxygenation (ECMO) is a method of life support for either isolated cardiac failure or respiratory failure, with or without cardiac failure. When used for hemodynamic support, the ECMO circuit presents a non-endothelialized, artificial surface to blood inciting an inflammatory response which activates haemostatic pathways. Anticoagulation may complicate a pre-existing coagulopathy and/or inadequate surgical hemostasis of varying severity. There is no standardized method to achieve and monitor anticoagulation or guide transfusion therapy during ECMO. We tested the hypothesis that institutions across the world conduct similar management of anticoagulation and transfusion during adult ECMO support.
This is a descriptive, self-reporting cross-sectional survey of anticoagulation and transfusion practice for patients age 18 or older on ECMO. This 38 multiple-choice question survey was sent to 166 institutions, internationally, utilizing adult ECMO. About 32·4% (54) of institutions responded. Responses were anonymously collected. Descriptive analyses were calculated.
Our findings indicate there appears to be a significant practice variation among institutions regarding anticoagulation and transfusion during adult ECMO support.
The lack of standard practices among institutions may reflect a paucity of data regarding optimal anticoagulation and transfusion for patients requiring ECMO. Standardized protocols for anticoagulation and transfusion may help increase quality of care for and reduce morbidity, mortality and cost to patients and healthcare centres. Further study is required for standardized, high quality care.
体外膜肺氧合（ECMO）是一种用于孤立性心力衰竭或呼吸衰竭（伴或不伴心力衰竭）的生命支持方法。当用于血流动力学支持时，ECMO回路为血液提供了一个非内皮化的人工表面，引发炎症反应，激活止血途径。抗凝可能会使已有的凝血障碍和/或不同严重程度的手术止血不充分情况复杂化。在ECMO期间，没有标准化的方法来实现和监测抗凝或指导输血治疗。我们检验了这样一个假设，即世界各地的机构在成人ECMO支持期间对抗凝和输血进行类似的管理。
这是一项针对18岁及以上接受ECMO治疗患者的抗凝和输血实践的描述性、自我报告横断面调查。这项包含38个选择题的调查被发送给国际上166个使用成人ECMO的机构。约32.4%（54个）机构做出了回应。回复是匿名收集的。进行了描述性分析。
我们的研究结果表明，在成人ECMO支持期间，各机构在抗凝和输血方面似乎存在显著的实践差异。
各机构缺乏标准做法可能反映出关于需要ECMO治疗的患者的最佳抗凝和输血的数据不足。标准化的抗凝和输血方案可能有助于提高护理质量，降低患者和医疗中心的发病率、死亡率及成本。需要进一步研究以实现标准化的高质量护理。
