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Factor XII promotes the thromboinflammatory response in a rat model of veno-arterial extracorporeal membrane oxygenation.

Abstract Objective  (FXII) is a multifunctional  capable of activating thrombotic and inflammatory pathways. FXII has been linked to thrombosis in  (ECMO), but the role of FXII in ECMO-induced inflammatory complications has not..

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Fibrin and Drainage Insufficiency on Extracorporeal Support: What Came First?

Abstract Drainage insufficiency is a common phenomenon during extracorporeal life support, related to a variable and potentially multiple etiologies. Being associated with impaired extracorporeal blood flow (EBF), so with impaired..

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How to Solve the Conundrum of Heparin-Induced Thrombocytopenia during Cardiopulmonary Bypass

Abstract Heparin-induced thrombocytopenia (HIT) is a major issue in cardiac surgery requiring cardiopulmonary bypass (CPB). HIT represents a severe adverse drug reaction after heparin administration. It consists of immune-mediated thrombocytopenia..

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Accurate protamine:heparin matching (not just smaller protamine doses) decreases postoperative bleeding in cardiac surgery; results from a high-volume academic medical…

Abstract Background A multidisciplinary Quality Assurance/Performance Improvement study to identify the incidence of “heparin rebound” in our adult cardiac surgical population instead detected a thromboelastometry pattern suggestive of initial protamine..

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Patient Blood Management in Pregnancy

Abstract Background: Patient blood management (PBM) is a multidisciplinary and patient-centered treatment approach, comprising the detection and treatment of anemia, the minimization of blood loss, and the rational use of allogeneic..

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Anticoagulation for cardiopulmonary bypass, Part 2: alternatives and pathological states

Abstract Pathophysiology There are two types of HIT, depending on the absence or presence of an immune mediation. Type 1 is a non-immune-mediated direct activation of platelets by heparin that..

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Validity and Utility of Early Parameters in TEG6s Platelet Mapping to Assess the Coagulation Status During Cardiovascular Surgery With Cardiopulmonary…

Abstract Background The aim of this retrospective observational study was to explore the early predictive parameters for maximum amplitude in the kaolin with heparinase (HKH) assay (MAHKH) of TEG6s Platelet Mapping..

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Correlations between the Circulating Level of Cell-Derived Microparticles and Surgical Variables in Heart Valve Surgery with Cardiopulmonary Bypass

Abstract Background: Cell-derived microparticles (MPs) as membrane vesicles are procoagulant. They play a role in surgical hemostasis. In this study, the correlations between the circulating level of cell-derived MPs and..

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Development and Validation of a Nomogram for Predicting Heparin Resistance in Neonates and Young Infants Undergoing Cardiac Surgery: A Retrospective…

Abstract BACKGROUND:  Heparin resistance (HR) is a common finding in pediatric cardiac surgery and generally refers to decreased sensitivity to heparin. Antithrombin (AT) deficiency is considered the primary mechanism of..

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The First Autoregulated Total Artificial Heart Implant in the United States

Abstract The Aeson total artificial heart provides right- and left-sided heart replacement for biventricular failure with notable improvements from prior generations. These include enhanced hemocompatibility and autoregulation enabling increased output in..

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A Narrative Review of the Impact of Extracorporeal Membrane Oxygenation on the Pharmacokinetics and Pharmacodynamics of Critical Care Therapies

Abstract Objective: Extracorporeal membrane oxygenation (ECMO) utilization is increasing on a global scale, and despite technological advances, minimal standardized approaches to pharmacotherapeutic management exist. This objective was to create a..

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Investigation of real-world heparin resistance and anticoagulation management prior to cardiopulmonary bypass: report from a nationwide survey by the Japanese…

Abstract Objective Heparin resistance is often encountered during cardiopulmonary bypass. Heparin dose and activated clotting time target values for the initiation of cardiopulmonary bypass are not yet universally standardized; further..

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Extracorporeal life support in thoracic emergencies—a narrative review of current evidence

Abstract Background and Objective: Resuscitative therapies for respiratory and cardiac failure are lifesaving and extended by using extracorporeal life support (ECLS) as mechanical circulatory support (MSC). This review informs the debate..

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Interaction Between Platelet and Fibrinogen on Clot Strength in Healthy Patients

Abstract Objective The purpose of this study was to explore the relationship between platelet concentration (PLT) (× 109/L) and clot strength measured by  maximum amplitude (TEG-MA) in healthy volunteers without a..

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Venovenous Extracorporeal CO2 removal to support ultraprotective ventilation in moderate-severe ARDS: A systematic review and meta-analysis of the literature

Abstract Background A strategy that limits tidal volumes and inspiratory pressures, improves outcomes in patients with the acute respiratory distress syndrome (ARDS). Extracorporeal carbon dioxide removal (ECCO2R) may facilitate ultra-protective ventilation...

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Veno-Arterial Extracorporeal Membrane Oxygenation for Amniotic Fluid Embolism: A Report From the Extracorporeal Life Support Organization Registry

Abstract Amniotic fluid embolism (AFE) is a potentially lethal complication of pregnancy that results from disruption of the maternal–fetal interface and occurs as frequently as one in every 8,000 deliveries. When AFE..

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Point-of-Care Viscoelastic Hemostatic Assays in Cardiac Surgery Patients: Comparison of Thromboelastography 6S, Thromboelastometry Sigma, and Quantra

Abstract Objectives Viscoelastic tests allow a reduction in blood product transfusion. Three modern devices are currently available (rotational  [ROTEM] sigma,  [TEG] 6S, and Quantra). No study has compared the performances of these..

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Modified Ultrafiltration Should Not Be Routinely Used in Adult Cardiac Surgery

Abstract Pediatric Literature As the practice of ultrafiltration arose from pediatric cardiac surgery, much of the evidence to support MUF is from low-powered pediatric studies. Some early, single-center literature, as..

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Modified Ultrafiltration Is Beneficial for Adults Undergoing Cardiac Surgery

Abstract Hemodilution and Volume Overload The use of CPB necessitates priming of the CPB circuit, which is typically accomplished using 1-to-2 liters of a crystalloid solution. In addition, 1-to-3 liters..

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Cytosorb Adsorption During Emergency Cardiac Operations in Patients at High Risk of Bleeding

Abstract Background The purpose of this study was to analyze the results of Cytosorb (CytoSorbents, Monmouth Junction, NJ) adsorption during emergency open heart operations in patients at high risk of..

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Neuromonitoring detects brain injury in patients receiving extracorporeal membrane oxygenation support

Abstract Objective There is limited evidence on standardized protocols for optimal neurological monitoring methods  receiving  (ECMO). We previously introduced protocolized noninvasive multimodal neuromonitoring using serial , electroencephalography,  ultrasound, and . The purpose of this study..

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Sodium citrate effectively used in shed mediastinal blood autotransfusion after cardiac surgery

Abstract Background We used sodium citrate as an alternative anticoagulation agent to heparin in the procedure of autologous blood transfusion with patients with postoperative haemorrhage after CPB. The aim of..

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Evaluation of Latex Immunoturbidimetric Assay Thresholds and HIT in Cardiothoracic Surgery

Abstract Background Heparin-induced thrombocytopenia (HIT) is a common differential diagnosis in cardiothoracic surgery. The latex immunoturbidimetric assay (LIA) is an enhanced immunoassay that has recently been introduced for the detection..

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In vitro study on the effect of fibrinogen γ-chain peptide-coated ADP-encapsulated liposomes on postcardiopulmonary bypass coagulopathy using patient blood

Abstract Background Fibrinogen γ-chain peptide-coated, adenosine 5'-diphosphate (ADP)-encapsulated liposomes (H12-ADP-liposomes) are potent hemostatic adjuvants that promote platelet thrombi formation at bleeding sites. Although we have reported the efficacy of these..

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Resistance to unfractionated heparin in the ICU: evaluation and management options

Abstract Because of its rapid onset and offset of action, and its ability to be fully and rapidly reversed with protamine when anticoagulation control is needed, unfractionated heparin (UFH) remains..

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Targeting the Contact Pathway of Coagulation for the Prevention and Management of Medical Device-Associated Thrombosis

Abstract Hemorrhage remains a major complication of anticoagulants, with bleeding leading to serious and even life-threatening outcomes in rare settings. Currently available anticoagulants target either multiple coagulation factors or specifically..

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The effects of differing anticoagulant regimes on blood quality after cell salvage in coronary artery bypass grafting (CABG): a pilot…

Abstract Background Cell salvage reduces allogenic blood transfusion requirements in surgery. We present a pilot study exploring the impact of anticoagulant choice, citrate or heparin, on the quality of cell..

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Comparison of anticoagulation monitoring strategies for adults supported on extracorporeal membrane oxygenation: A systematic review

Abstract Background Anticoagulation is critical in patients supported on extracorporeal membrane oxygenation (ECMO). The appropriate monitoring strategies for heparin remain unclear. Objectives This systematic review aimed to compare the accuracy..

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Bacteria in Extracorporeal Membrane Oxygenation Circuit Clots of a Patient With Persistent Bacteremia: A Case Report

Abstract A neonate with pulmonary hypertension was supported with extracorporeal membrane oxygenation (ECMO). During ECMO support, the patient developed Enterococcus faecalis bacteremia, treated with targeted antibiotics. Despite the maximum dose of antibiotics, routine blood..

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Coagulation support during perioperative bleeding management

Abstract Bleeding is a leading cause of perioperative mortality []. In a perioperative setting, damage control surgery with massive transfusion protocols (MTPs) are therapeutic approaches used clinically to manage patients..

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