Lehle Karla, Philipp Alois, Krenkel Lars, Gruber Michael, Hiller Karl-Anton, Müller Thomas, Lubnow Matthias
From the Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany.
Department of Biofluid Mechanics, Technical University of Applied Sciences Regensburg and Regensburg Center of Biomedical Engineering, OTH and University of Regensburg, Regensburg, Germany.
ASAIO J. 2025 Jun 1;71(6):498-509. doi: 10.1097/MAT.0000000000002383. Epub 2025 Jan 28.
Contact of blood with artificial surfaces triggers platelet activation. The aim was to compare platelet kinetics after venovenous extracorporeal membrane oxygenation (V-V ECMO) start and after system exchange in different etiologies of acute lung failure. Platelet counts and coagulation parameters were analyzed from adult patients with long and exchange-free (≥8 days) ECMO runs (n = 330) caused by bacterial (n = 142), viral (n = 76), or coronavirus disease 2019 (COVID-19) (n = 112) pneumonia. A subpopulation requiring a system exchange and with long, exchange-free runs of the second oxygenator (≥7 days) (n = 110) was analyzed analogously. Patients with COVID-19 showed the highest platelet levels before ECMO implantation. Independent of the underlying disease and ECMO type, platelet counts decreased significantly within 24 hours and reached a steady state after 5 days. In the subpopulation, at the day of a system exchange, platelet counts were lower compared with ECMO start, but without differences between underlying diseases. Subsequently, platelets remained unchanged in the bacterial pneumonia group, but increased in the COVID-19 and viral pneumonia groups within 2-4 days, whereas D-dimers decreased and fibrinogen levels increased. Thus, overall platelet counts on V-V ECMO show disease-specific initial dynamics followed by an ongoing consumption by the ECMO device, which is not boosted by new artificial surfaces after a system exchange.
血液与人工表面接触会引发血小板活化。本研究旨在比较静脉-静脉体外膜肺氧合（V-V ECMO）启动后以及不同病因的急性肺衰竭患者进行系统更换后的血小板动力学。对因细菌（n = 142）、病毒（n = 76）或2019冠状病毒病（COVID-19）（n = 112）肺炎而接受长时间且无系统更换（≥8天）ECMO治疗的成年患者（n = 330）的血小板计数和凝血参数进行了分析。对需要进行系统更换且第二个氧合器长时间无系统更换运行（≥7天）的亚组患者（n = 110）进行了类似分析。COVID-19患者在植入ECMO前血小板水平最高。无论潜在疾病和ECMO类型如何，血小板计数在24小时内显著下降，并在5天后达到稳定状态。在亚组中，系统更换当天的血小板计数低于ECMO启动时，但不同潜在疾病之间无差异。随后，细菌性肺炎组的血小板数量保持不变，但COVID-19组和病毒性肺炎组的血小板数量在2 - 4天内增加，而D-二聚体下降，纤维蛋白原水平升高。因此，V-V ECMO上的总体血小板计数呈现出疾病特异性的初始动态变化，随后ECMO装置持续消耗血小板，系统更换后新的人工表面不会增加血小板消耗。
