From the ASST Monza, Ospedale San Gerardo, Dipartimento di Emergenza-Urgenza, Monza, Italy.
Università degli Studi di Milano-Bicocca, Dipartimento di Medicina e Chirurgia, Monza, Italy.
ASAIO J. 2021 Feb 1;67(2):196-200. doi: 10.1097/MAT.0000000000001196.
Optimal anticoagulation monitoring in patients with extracorporeal membrane oxygenation (ECMO) is fundamental to avoid hemorrhagic and thromboembolic complications. Besides conventional coagulation tests, there is growing interest in the use of viscoelastic hemostatic assays (VHA), in particular of tromboelastography (TEG). Evidence on the use of rotational thromboelastometry (ROTEM) is lacking in this setting. The aim of the study was to evaluate ROTEM as a tool for assessing hemostasis during ECMO, by comparing it to TEG and conventional coagulation assays. We conducted a prospective, observational, single-center study on adult patients on ECMO support anticoagulated with unfractioned heparin (UFH). Kaolin reaction time (R, min) for TEG and INTEM clotting time (CT, sec) for ROTEM were analyzed and compared with conventional coagulation tests. In the study period, we included 25 patients on ECMO support (14 V-A and 11 V-V); 84 data points were available for the analysis. Median UFH infusion rate was 15 [11-18] IU/min/kg. Median values for activated partial thromboplastin time (aPTT) ratio, Kaolin TEG R time, and INTEM CT were 1.44 [1.21-1.7], 22 [13-40] min, and 201 [183-225] sec, respectively. INTEM CT (ROTEM) showed a moderate correlation with standard coagulation tests (R2 = 0.34 and 0.3 for aPTT and activated clotting time (ACT), respectively, p < 0.001). No significant correlation was found between INTEM CT and Kaolin R time (R2 = 0.01). Further studies are needed to identify an appropriate anticoagulation target for ROTEM during ECMO.
在体外膜肺氧合（ECMO）患者中进行最佳抗凝监测对于避免出血和血栓栓塞并发症至关重要。除了常规凝血试验外，人们对使用粘弹性止血测定法（VHA），特别是血栓弹性描记法（TEG）越来越感兴趣。在这种情况下，旋转血栓弹性描记法（ROTEM）的使用证据不足。本研究旨在通过将其与 TEG 和常规凝血试验进行比较，评估 ROTEM 作为评估 ECMO 期间止血的工具。
我们进行了一项前瞻性、观察性、单中心研究，纳入了接受未分馏肝素（UFH）抗凝的 ECMO 支持的成年患者。分析和比较了 TEG 的高岭土反应时间（R，分钟）和 ROTEM 的 INTEM 凝血时间（CT，秒）与常规凝血试验。在研究期间，我们纳入了 25 名接受 ECMO 支持的患者（14 名 V-A 和 11 名 V-V）；可用于分析的有 84 个数据点。UFH 输注率中位数为 15 [11-18] IU/min/kg。活化部分凝血活酶时间（aPTT）比值、高岭土 TEG R 时间和 INTEM CT 的中位数分别为 1.44 [1.21-1.7]、22 [13-40] 分钟和 201 [183-225] 秒。INTEM CT（ROTEM）与标准凝血试验呈中度相关（R2 分别为 0.34 和 0.3，用于 aPTT 和活化凝血时间（ACT），p<0.001）。INTEM CT 与高岭土 R 时间无显著相关性（R2 = 0.01）。需要进一步研究以确定 ECMO 期间 ROTEM 的适当抗凝目标。
