title: Decreased maximum clot firmness in rotational thromboelastometry (ROTEM®) is associated with bleeding during extracorporeal mechanical circulatory support.
abstract: We aimed to characterize the coagulation disturbances which may increase the risk of bleeding, thrombosis or death shortly after implantation of an extracorporeal membrane oxygenation (ECMO) or ventricular assist (VAD) device.
  Antithrombotic treatment was started in 23 VAD and 24 ECMO patients according to the hospital protocol. Additionally, conventional laboratory testing, rotational thromboelastometry (ROTEM®) and platelet function analysis (Multiplate®) were performed at predetermined intervals.
  Four out of twenty-four (16.7%) of ECMO patients and 6/23 (26.1%) of VAD patients had severe bleeding after the procedure. When all the patients were analyzed together, low maximum clot firmness (MCF) in ExTEM and FibTEM analyses was associated with severe bleeding (p<0.05) and low MCF in FibTEM with 30-day mortality. Low platelet count and hematocrit levels were also associated with severe bleeding. When VAD and ECMO patients were separated into different groups, the association between ROTEM® parameters, bleeding and survival was found only in limited time points. Four patients with VAD had cerebral ischemia indicative of thromboembolism. However, this had no significant correlation with ROTEM® or Multiplate® parameters.
  Hypocoagulation shown by ROTEM® was associated with bleeding complications in patients with mechanical circulatory support. In contrast, hypercoagulation did not correlate with clinical thrombosis.
authors.affiliation: 1 Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Laine
authors.affiliation: 1 Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Tomi
authors.initials: T
authors.lastname: Niemi
authors.affiliation: 2 Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Raili
authors.initials: R
authors.lastname: Suojaranta-Ylinen
authors.affiliation: 3 Heart and Lung Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Peter
authors.initials: P
authors.lastname: Raivio
authors.affiliation: 2 Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Leena
authors.initials: L
authors.lastname: Soininen
authors.affiliation: 3 Heart and Lung Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Karl
authors.initials: K
authors.lastname: Lemström
authors.affiliation: 3 Heart and Lung Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Hämmäinen
authors.affiliation: 1 Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.|2 Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Alexey
authors.initials: A
authors.lastname: Schramko
keywords: ECMO; VAD; bleeding; coagulation; thrombosis