PMID- 27543261
OWN - NLM
STAT- MEDLINE
DCOM- 20180205
LR  - 20180226
IS  - 1532-9496 (Electronic)
IS  - 0887-7963 (Linking)
VI  - 30
IP  - 4
DP  - 2016 Oct
TI  - Challenges with Navigating the Precarious Hemostatic Balance during 
      Extracorporeal Life Support: Implications for Coagulation and Transfusion 
      Management.
PG  - 223-9
LID - S0887-7963(16)30043-8 [pii]
LID - 10.1016/j.tmrv.2016.07.005 [doi]
AB  - For the past four decades, extracorporeal life support (ECLS) has been used to 
      treat critically ill adult and pediatric patients with cardiac and/or respiratory 
      failure, and there are increasingly numbers of centers worldwide performing ECLS 
      for numerous indications. Despite the progress with advancing the technology, 
      hemorrhagic and thrombotic complications are frequently reported and associated 
      with worse outcomes, but the exact cause is often elusive or multifactorial. As a 
      result of the interaction between blood and an artificial circuit, 
      anticoagulation is necessary and there is resultant activation of coagulation, 
      fibrinolysis, as well as, an increased inflammatory response. While 
      unfractionated heparin (UFH) remains the mainstay anticoagulant used during ECLS, 
      there is a paucity of published data to develop a universal anticoagulation 
      guideline and centers are forced to create individualized protocols to guide 
      anticoagulation management while lacking expertise. From an international survey, 
      centers often use a combination of tests, which in turn result in discordant 
      results and confused management. Studies are urgently needed to investigate 
      optimization of current anticoagulation strategies with UFH, as well as, use of 
      alternative anticoagulants and non-thrombogenic biomaterials. Blood transfusion 
      during extracorporeal support typically occurs for several reasons, which 
      includes circuit priming, restoration of oxygen carrying capacity, maintenance of 
      a hemostatic balance, and treatment of hemorrhagic complications. As a result, 
      the majority of patients will have been exposed to at least one blood product 
      during extracorporeal support and transfusion utilization is high. ECLS Centers 
      have adopted transfusion thresholds based upon practice rather than evidence as 
      there have been no prospective studies investigating the efficacy of red cell 
      (RBC) transfusion in patients receiving extracorporeal support. In addition, RBC 
      transfusion has been associated with increased mortality in ECLS in several 
      retrospective studies. Additional studies are needed to establish evidence based 
      thresholds for transfusion support and diagnostics to guide transfusion therapy 
      to assess efficacy of transfusion in this population, as well as, exploration of 
      alternatives to transfusion.
CI  - Copyright (c) 2016 Elsevier Inc. All rights reserved.
FAU - Andrews, Jennifer
AU  - Andrews J
AD  - Departments of Pathology and Pediatrics, Stanford University School of Medicine.
FAU - Winkler, Anne M
AU  - Winkler AM
AD  - Department of Pathology and Laboratory Medicine, Emory University School of 
      Medicine. Electronic address: awinkl2@emory.edu.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20160804
PL  - United States
TA  - Transfus Med Rev
JT  - Transfusion medicine reviews
JID - 8709027
RN  - 0 (Anticoagulants)
RN  - 0 (Hemostatics)
RN  - 9005-49-6 (Heparin)
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - Adolescent
MH  - Anticoagulants/administration & dosage/therapeutic use
MH  - Blood Coagulation/*drug effects
MH  - Blood Transfusion
MH  - Child
MH  - Child, Preschool
MH  - Extracorporeal Membrane Oxygenation/*adverse effects
MH  - Female
MH  - Hematology/methods/*standards
MH  - Hemostasis
MH  - Hemostatics
MH  - Heparin/*administration & dosage/therapeutic use
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Oxygen/chemistry
MH  - Platelet Transfusion/adverse effects
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Extracorporeal life support
OT  - Extracorporeal membrane oxygenation
OT  - Heparin monitoring
OT  - Transfusion
EDAT- 2016/08/21 06:00
MHDA- 2018/02/06 06:00
CRDT- 2016/08/21 06:00
PHST- 2016/04/22 00:00 [received]
PHST- 2016/07/19 00:00 [revised]
PHST- 2016/07/29 00:00 [accepted]
PHST- 2016/08/21 06:00 [entrez]
PHST- 2016/08/21 06:00 [pubmed]
PHST- 2018/02/06 06:00 [medline]
AID - S0887-7963(16)30043-8 [pii]
AID - 10.1016/j.tmrv.2016.07.005 [doi]
PST - ppublish
SO  - Transfus Med Rev. 2016 Oct;30(4):223-9. doi: 10.1016/j.tmrv.2016.07.005. Epub 
      2016 Aug 4.