PMID- 33735282
OWN - NLM
STAT- MEDLINE
DCOM- 20211012
LR  - 20211012
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 16
IP  - 3
DP  - 2021
TI  - Different mechanisms of oxygenator failure and high plasma von Willebrand factor 
      antigen influence success and survival of venovenous extracorporeal membrane 
      oxygenation.
PG  - e0248645
LID - 10.1371/journal.pone.0248645 [doi]
LID - e0248645
AB  - OBJECTIVE: Failure of membrane oxygenator (MO) function of venovenous 
      extracorporeal membrane oxygenators (VV ECMO) remains problematic. The 
      development of device-induced coagulation disorder (COD) or worsened gas transfer 
      (WGT) necessitates a system exchange. The aim was to correlate von Willebrand 
      factor antigen (vWF:Ag) with the predisposition to MO failure and mortality. 
      METHODS: Laboratory parameters (inflammation, coagulation) and ECMO-related data 
      from 31 VV ECMO patients were analyzed before and after the first MO exchange. 
      Study groups were identified according to the exchange reasons (COD, WGT) and the 
      extent of vWF:Ag (low, </=425%; high, >425%). RESULTS: vWF:Ag remained unchanged 
      after system exchange. High vWF:Ag was associated with systemic endothelial 
      activation of older and obese patients with elevated SOFA score, increased 
      norepinephrine and higher requirement of continuous renal replacement therapy 
      without an effect on MO runtime and mortality. Including the mechanism of MO 
      failure (COD, WGT), various patient group emerged. COD/low vWF:Ag summarized 
      younger and less critically ill patients that benefit mainly from ECMO by a 
      significant improvement of their inflammatory and coagulation status (CRP, 
      D-dimers, fibrinogen) and highest survival rate (91%). Instead, WGT/high vWF:Ag 
      presented older and more obese patients with a two-digit SOFA score, highest 
      norepinephrine, and aggravated gas transfer. They benefited temporarily from 
      system exchange but with worst survival (33%). CONCLUSIONS: vWF:Ag levels alone 
      cannot predict early MO failure and outcome in VV ECMO patients. Probably, the 
      mechanism of clotting disorder in combination with the vWF:Ag level seems to be 
      essential for clot formation within the MO. In addition, vWF:Ag levels allows the 
      identification different patient populations In particular, WGT/high vWF:Ag 
      represented a critically ill population with higher ECMO-associated mortality.
FAU - Steiger, Tamara
AU  - Steiger T
AD  - Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, 
      Germany.
FAU - Philipp, Alois
AU  - Philipp A
AD  - Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, 
      Germany.
FAU - Hiller, Karl-Anton
AU  - Hiller KA
AUID- ORCID: 0000-0002-4726-9555
AD  - Department of Conservative Dentistry and Periodontology, University Hospital 
      Regensburg, Regensburg, Germany.
FAU - Muller, Thomas
AU  - Muller T
AD  - Department of Internal Medicine II, University Hospital Regensburg, Regensburg, 
      Germany.
FAU - Lubnow, Matthias
AU  - Lubnow M
AUID- ORCID: 0000-0002-4402-1810
AD  - Department of Internal Medicine II, University Hospital Regensburg, Regensburg, 
      Germany.
FAU - Lehle, Karla
AU  - Lehle K
AUID- ORCID: 0000-0001-8856-4094
AD  - Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, 
      Germany.
LA  - eng
PT  - Journal Article
DEP - 20210318
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Antigens)
RN  - 0 (von Willebrand Factor)
SB  - IM
MH  - Acute Lung Injury/blood/*therapy
MH  - Adult
MH  - Aged
MH  - Antigens/blood/immunology
MH  - Blood Coagulation Tests/methods
MH  - Equipment Failure/*statistics & numerical data
MH  - Extracorporeal Membrane Oxygenation/*adverse effects/instrumentation/statistics & 
      numerical data
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Oxygenators, Membrane/*adverse effects/statistics & numerical data
MH  - Retrospective Studies
MH  - Risk Assessment/methods/statistics & numerical data
MH  - Thrombosis/blood/diagnosis/*epidemiology/etiology
MH  - Young Adult
MH  - von Willebrand Factor/immunology
PMC - PMC7971568
COIS- The authors have declared that no competing interests exist.
EDAT- 2021/03/19 06:00
MHDA- 2021/10/13 06:00
PMCR- 2021/03/18
CRDT- 2021/03/18 17:38
PHST- 2020/09/22 00:00 [received]
PHST- 2021/03/03 00:00 [accepted]
PHST- 2021/03/18 17:38 [entrez]
PHST- 2021/03/19 06:00 [pubmed]
PHST- 2021/10/13 06:00 [medline]
PHST- 2021/03/18 00:00 [pmc-release]
AID - PONE-D-20-29802 [pii]
AID - 10.1371/journal.pone.0248645 [doi]
PST - epublish
SO  - PLoS One. 2021 Mar 18;16(3):e0248645. doi: 10.1371/journal.pone.0248645. 
      eCollection 2021.