title: Prospective observational study of hemostatic alterations during adult extracorporeal membrane oxygenation (ECMO) using point-of-care thromboelastometry and platelet aggregometry.
abstract: OBJECTIVE
  To characterize the longitudinal hemostatic profile during adult ECMO using point-of-care tests (POCT) for coagulation and to compare these parameters to standard laboratory tests. In addition, the clinicians' responses during bleeding episodes using available information were compared to a POCT-based response.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  ECMO-referral center in a university teaching hospital.
  
  
  METHODS
  Ten critically ill adult ECMO patients.
  
  
  METHODS
  Daily laboratory coagulation profile, transfusion history and near-daily thromboelastometry (ROTEM®) and platelet aggregometry (Multiplate®).
  
  
  RESULTS
  Six male and four female patients, seven with VA- and three with VV-ECMO were studied over 110 days. Seventy-five thromboelastometry (TEM) and 36 platelet aggregometry (MEA) results were analyzed. A majority of TEM values were within the normal range, except for FIBTEM (majority high), which remained consistent over long (>5 days) ECMO runs. In MEA there were low values, particularly in the adenosine diphosphate- and ristocetin-induced assay, implying possibly a vWF-factor or GpIb-receptor defect. There was correlation between laboratory and POCT as well as good correlation between the clot firmness after 10 minutes (A10) and the maximum clot firmness in ROTEM, suggesting that reliable information can be obtained within 15 minutes. Twenty-two bleeding episodes were observed in five patients. When comparing the clinicians' response to a transfusion algorithm based on POCT, there was a concordance in less than 20% of episodes.
  
  
  CONCLUSIONS
  POCT for coagulation can provide specific, reliable, and timely information during bleeding episodes and the use of targeted therapy algorithms could improve outcomes and reduce costs.
authors: Intensive Care Unit, St Vincents Hospital, Sydney, Australia; University of New South Wales, Australia. Electronic address: pnair@stvincents.com.au.
authors: Priya
authors: P
authors: Nair
authors: Department of Anesthesiology, University of Munich (LMU), Munich, Germany.
authors: Dominik Johannes
authors: DJ
authors: Hoechter
authors: Intensive Care Unit, St Vincents Hospital, Sydney, Australia; University of New South Wales, Australia.
authors: Hergen
authors: H
authors: Buscher
authors: University of New South Wales, Australia.
authors: Karthik
authors: K
authors: Venkatesh
authors: Intensive Care Unit, St Vincents Hospital, Sydney, Australia.
authors: Susan
authors: S
authors: Whittam
authors: University of New South Wales, Australia; Department of Hematology, St Vincents Hospital, Sydney, Australia.
authors: Joanne
authors: J
authors: Joseph
authors: University of New South Wales, Australia; Department of Cardiothoracic Surgery, St Vincents Hospital, Sydney, Australia.
authors: Paul
authors: P
authors: Jansz
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D001780:Blood Coagulation Tests / Q000379:methods; D001792:Blood Platelets; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count / Q000706:statistics & numerical data; D019095:Point-of-Care Systems; D011446:Prospective Studies; D013916:Thrombelastography / Q000706:statistics & numerical data*
keywords: ECMO; ROTEM; coagulation abnormalities; coagulation monitoring; platelet aggregometry