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Use of bivalirudin for anticoagulation in pediatric extracorporeal membrane oxygenation (ECMO)

Abstract This study describes the use of bivalirudin in children on extracorporeal membrane oxygenation (ECMO). Pediatric patients receiving bivalirudin were compared to patients receiving heparin as the anticoagulant on ECMO...

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Thrombin: A Pivotal Player in Hemostasis and Beyond

Abstract The serine protease thrombin, a naturally derived enzyme, plays a key role in hemostasis by converting fibrinogen to fibrin and activating coagulation factor XIII whereby the fibrin clot is..

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Native Aortic Root Thrombosis After Norwood Palliation for Hypoplastic Left Heart Syndrome

Abstract Background Norwood palliation for hypoplastic left heart syndrome typically results in retrograde perfusion of the native aortic root. This may predispose to native aortic root thrombosis (NART). Methods Patients..

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The use of thromboelastography (TEG) and rotational thromboelastometry (ROTEM) in neonates: a systematic review

Abstract “Developmental hemostasis” refers to the dynamic process of gradual hemostatic maturation. Conventional coagulation tests seem to fail to accurately depict the in vivo hemostasis, while viscoelastic tests, thromboelastography (TEG),..

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Evaluation of the impact of HMS Plus on postoperative blood loss compared with ACT Plus in cardiac surgery

Abstract BACKGROUND: The standardized management of anticoagulation during the cardiopulmonary bypass seems inaccurate because of patients and surgeries variability. This study evaluates if an individualized management of heparin and protamine..

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A Standardized Approach Improves Outcomes of Extracorporeal Membrane Oxygenation for Postcardiotomy Shock

Abstract Postcardiotomy shock (PCS) has historically been associated with substantial morbidity and mortality. Mortality at discharge is reportedly more than 60%. We investigated the outcomes of our standardized approach to..

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Variability of three activated clotting time point-of-care systems in cardiac surgery: reinforcing available evidence

Abstract Background: Cardiac surgery with extracorporeal circulation (ECC) requires the administration of anticoagulant drugs to maintain ACT ranges 400–600 seconds, which requires exhaustive coagulation monitoring for which various point-of-care devices..

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Optimal protamine dosing after cardiopulmonary bypass: The PRODOSE adaptive randomised controlled trial

Abstract Background The dose of protamine required following cardiopulmonary bypass (CPB) is often determined by the dose of heparin required pre-CPB, expressed as a fixed ratio. Dosing based on mathematical..

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The Evolution of the Use of Extracorporeal Membrane Oxygenation in Respiratory Failure

Abstract Extracorporeal membrane oxygenation (ECMO) has been used with increasing frequency to support patients with acute respiratory failure, most commonly, and severe forms of acute respiratory distress syndrome (ARDS). The..

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Anticoagulation and Transfusion Management During Neonatal and Pediatric Extracorporeal Membrane Oxygenation: A Survey of Medical Directors in the United States

Abstract OBJECTIVES:  To compare current practices within the United States of anticoagulation management and blood transfusion in neonatal and pediatric extracorporeal membrane oxygenation patients with a 2013 international report. DESIGN: ..

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Novel application of indocyanine green fluorescence imaging for real-time detection of thrombus in a membrane oxygenator

Abstract Extracorporeal membrane oxygenation (ECMO) plays an important role in the coronavirus disease 2019 (COVID-19) pandemic. Management of thrombi in ECMO is generally an important issue; especially in ECMO for..

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Validation of the relationship between coagulopathy and localization of hydroxyethyl starch on the vascular endothelium in a rat hemodilution model

Abstract Various anticoagulant properties have been associated with hydroxyethyl starch (HES). However, the mechanism remains unclear and it has not been fully considered whether these properties are beyond the dilutional..

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Comparison of Anticoagulation Strategies in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation: Heparin Versus Bivalirudin

Abstract OBJECTIVES:  Extracorporeal membrane oxygenation is a life-sustaining therapy for severe respiratory failure. Extracorporeal membrane oxygenation circuits require systemic anticoagulation that creates a delicate balance between circuit-related thrombosis and bleeding-related..

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Understanding and managing the complex balance between bleeding and thrombosis following cardiopulmonary bypass in paediatric cardiac surgical patients

Abstract Bleeding in the perioperative period of congenital heart surgery with cardiopulmonary bypass is associated with increased morbidity and mortality both from the direct effects of haemorrhage as well as..

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Bivalirudin May Reduce the Need for Red Blood Cell Transfusion in Pediatric Cardiac Patients on Extracorporeal Membrane Oxygenation

Abstract We retrospectively compared anticoagulation with heparin and bivalirudin for 32 consecutive children under 18 years old during extracorporeal membrane oxygenation (ECMO) in our pediatric cardiac intensive care unit (PCICU). Between September..

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Blood Pumps for Extracorporeal Membrane Oxygenation

Abstract Extracorporeal membrane oxygenation (ECMO) is a therapy used in severe cardiopulmonary failure. Blood is pumped through an artificial circuit exposing it to nonphysiologic conditions, which promote platelet activation and..

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Association of Plasma Fibrinogen and Thromboelastography With Blood Loss in Complex Cardiac Surgery

Abstract Postoperative coagulopathic bleeding is common in cardiac surgery and is associated with increased morbidity and mortality. Ideally, real-time information on in-vivo coagulation should be available. However, up to now..

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The assessment of patients undergoing cardiac surgery for Covid-19: Complications occurring during cardiopulmonary bypass

Abstract The outbreak of the novel coronavirus pandemic (COVID-19) has resulted in dramatic changes to the conduct of surgery both from a patient management perspective and in protecting healthcare providers...

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THE STANDARD POINT-OF-CARE HEMOCHRON® JR. ACT+ TEST IN MONITORING HEPARIN ADMINISTRATION FOR CARDIOPULMONARY BYPASS IN SEVERE FACTOR XII DEFICIENCY

Abstract Coagulation factor XII (fXII) is a plasma serine protease which belongs to the contact activation complex responsible for initiating the intrinsic coagulation pathway. fXII deficiency is a rare congenital..

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The Effects of the Combined Argatroban/Nitric Oxide-Releasing Polymer on Platelet Microparticle-Induced Thrombogenicity in Coated Extracorporeal Circuits

Abstract Clotting, anticoagulation, platelet consumption, and poor platelet function are major factors in clinical extracorporeal circulation (ECC). We have shown that nitric oxide-releasing (NOReL) coatings prevent thrombosis in a rabbit..

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Altered Fibrinolysis during and after Surgery

Abstract Major surgery induces hemostatic changes related to surgical stress, tissue destruction, and inflammatory reactions. These changes involve a shift of volume from extravascular space to intravascular and interstitial spaces,..

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Lambl's excrescences

Lambl's excrescences are usually described as filiform (threadlike) fronds.  They were first described by Vilem Dusan Lambl, a Bohemian physician. They occur, by definition, along valve closure lines, where minor..

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Heparin-induced thrombocytopenia: construction of a pre-test diagnostic score derived from the analysis of a prospective multinational database, with internal validation

Abstract Background Diagnosis of heparin-induced thrombocytopenia (HIT) requires pre-test probability assessment and dedicated laboratory assays. Objective To develop a pre-test score for HIT. Design Observational; analysis of prospectively collected data..

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Anticoagulation and In-Hospital Mortality From Coronavirus Disease 2019: A Systematic Review and Meta-Analysis

Abstract Hypercoagulability in coronavirus disease 2019 (COVID-19) may aggravate disease severity during hospitalization but the reported survival benefits from anticoagulation (AC) vary among studies. We performed a literature research to..

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Rheumatic heart disease: The role of global cardiac surgery

Abstract Rheumatic heart disease (RHD) remains a neglected disease of poverty. While nearly eradicated in high‐income countries due to timely detection and treatment of acute rheumatic fever, RHD remains highly..

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Anticoagulation in Critically Ill Adults during Extracorporeal Circulation

Abstract Extracorporeal circuits including renal replacement therapy, extracorporeal membrane oxygenation, and ventricular assist devices are increasingly used in critically ill patients. The need for anticoagulation to provide circuit patency and..

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Brain Injury in Extracorporeal Membrane Oxygenation: A Multidisciplinary Approach

Abstract Extracorporeal membrane oxygenation (ECMO) represents an established technique to provide temporary cardiac and/or pulmonary support. ECMO, in veno-venous, veno-arterial or in extracorporeal carbon dioxide removal modality, is associated with..

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How would we treat our own heparin-induced thrombocytopenia during cardiac surgery?

Abstract The aim of this article is to provide a comprehensive review of the current state of knowledge on heparin-induced thrombocytopenia (HIT) in cardiac surgery. The management of HIT patients..

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Guidelines for Conduct of Cardiopulmonary Bypass

Abstract THE USE of cardiopulmonary bypass has enabled the delivery of complex cardiovascular surgical procedures. Cardiopulmonary bypass (CPB), at its best, involves a highly technical process that is executed carefully..

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Antiphospholipid Syndrome and Cardiac Bypass: The Careful Balance between Clotting and Bleeding

Abstract Antiphospholipid syndrome (APS) is an acquired autoimmune condition characterized by the presence of antiphospholipid antibodies (lupus anticoagulant, anticardiolipin antibody, and anti-β2 glycoprotein-I antibody) which leads to clinical thrombosis via a..

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