Koeltz Adrien, Gendron Nicolas, Ajzenberg Nadine, Longrois Dan
Département d'Anesthésie-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France.
Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France.
J Extra Corpor Technol. 2018 Dec;50(4):256-259.
Extracorporeal life support (ECLS) is increasingly used as a rescue therapy in patients with refractory cardiac/respiratory failure for temporary support or bridge to decision-making in both adult and pediatric patients. Complications such as bleeding and thrombosis remain major causes of morbidity and mortality in patients treated with ECLS. Hemostatic complications related to ECLS are multifactorial in patients with multiple organ dysfunctions and are incompletely characterized. Persisting thrombocytopenia and/or platelet dysfunction is the most frequent one. Herein, we report the case of a patient who developed severe thrombocytopenia after 5 days of ECLS associated with thrombi deposition in the circuit and oxygenator. After ECLS circuit and membrane change, we observed an increase and normalization in platelet count in 3 days. We propose a case-based reasoning to manage thrombocytopenia with ECLS.
体外生命支持(ECLS)越来越多地被用作难治性心脏/呼吸衰竭患者的抢救治疗手段,为成人和儿童患者提供临时支持或作为决策桥梁。出血和血栓形成等并发症仍然是接受ECLS治疗患者发病和死亡的主要原因。在多器官功能障碍患者中,与ECLS相关的止血并发症是多因素的,其特征尚未完全明确。持续性血小板减少和/或血小板功能障碍是最常见的情况。在此,我们报告一例患者,其在ECLS治疗5天后出现严重血小板减少,伴有回路和氧合器内血栓形成。更换ECLS回路和膜后,我们观察到血小板计数在3天内升高并恢复正常。我们提出基于病例的推理方法来处理ECLS相关的血小板减少症。