Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Perfusion. 2021 Sep;36(6):592-602. doi: 10.1177/02676591211001791. Epub 2021 Mar 15.
Thromboembolism and bleeding contribute to Coronavirus disease 2019 (COVID-19)'s morbidity and mortality and are also frequent complications of venovenous extracorporeal membrane oxygenation (vvECMO). As the interaction of the underlying pathologies caused by vvECMO in COVID-19 is barely understood, we designed this study to better differentiate coagulation disorders in COVID-19 patients before, during and after vvECMO-support.
Observational case series, six consecutive patients with Coronavirus acute respiratory distress syndrome supported with vvECMO treated in the anaesthesiologic ICU in a third level University ECMO-centre. We measured routine coagulation parameters and assessed coagulation factors. We also conducted advanced von Willebrand factor (VWF) multimer analysis, platelet aggregometry and immunological screening.
We identified various phases of coagulation disorders: Initially, intensely activated coagulation with highly increased VWF and factor VIII activity in acute COVID-19, then severe acquired von Willebrand syndrome and platelet dysfunction during vvECMO leading to spontaneous bleeding and finally, hypercoagulopathy after vvECMO explantation. Five of six patients developed immunological abnormalities enhancing coagulation.
Coronavirus-induced coagulopathy and bleeding disorders during vvECMO cannot be discriminated via 'routine' coagulation tests. Precise and specific analyses followed by the appropriate treatment of coagulation disorders may help us develop tailored therapeutic concepts to better manage the phases described above.
血栓栓塞和出血是导致 2019 年冠状病毒病（COVID-19）发病率和死亡率的原因，也是静脉-静脉体外膜肺氧合（vvECMO）的常见并发症。由于 vvECMO 引起的 COVID-19 潜在病理学之间的相互作用几乎不被理解，因此我们设计了这项研究，以更好地在 vvECMO 支持之前、期间和之后区分 COVID-19 患者的凝血障碍。
观察性病例系列研究，连续六例在三级大学 ECMO 中心的麻醉学 ICU 接受 vvECMO 支持的 COVID-19 急性呼吸窘迫综合征患者。我们测量了常规凝血参数并评估了凝血因子。我们还进行了先进的血管性血友病因子（VWF）多聚体分析、血小板聚集测定和免疫筛选。
我们确定了不同阶段的凝血障碍：最初，急性 COVID-19 中强烈激活的凝血伴有高度增加的 VWF 和因子 VIII 活性，然后在 vvECMO 期间发生严重的获得性血管性血友病和血小板功能障碍，导致自发性出血，最后在 vvECMO 取出后发生高凝状态。六名患者中有五名发生了增强凝血的免疫异常。
vvECMO 期间的冠状病毒诱导的凝血障碍和出血障碍不能通过“常规”凝血试验来区分。通过精确和特异性分析，然后对凝血障碍进行适当治疗，可能有助于我们制定量身定制的治疗概念，以更好地管理上述各阶段。
