Objectives
The objective was to compare primary hemostasis between adult ECMO patients and cardiac
surgical patients before heparinization and cardiopulmonary bypass. Furthermore, the
authors explored whether in vitro treatment of ECMO patient blood samples with recombinant
von Willebrand Factor (vWF) or lyophilized platelets improved primary hemostasis in
vitro.
Design
Prospective cohort study.
Setting
Single academic medical center.
Participants
Ten cardiac surgical patients and 8 adult ECMO patients.
Interventions
Cardiac surgical patients and ECMO patients had blood samples collected, and in vitro
platelet thrombus formation was assessed using the ATLAS PST device. The ECMO patients
had platelet thrombus formation evaluated at baseline and after in vitro treatment
with recombinant vWF or lyophilized platelets, whereas cardiac surgical patients had
a single blood sample obtained before heparinization and cardiopulmonary bypass run.
Measurements and Main Results
Median maximum force (39.7 v 260.2 nN) and thrombus area (0.05 v 0.11) at 5 minutes were lower in untreated ECMO patient samples compared with cardiac
surgical patients (p = 0.008 and p < 0.001, respectively). The ECMO patient samples
treated with recombinant vWF demonstrated an increase in both platelet maximum force
(median value of 222.1 v 39.7 nN) (p = 0.01) and platelet thrombus area (median value of 0.16 v 0.05; p = 0.001). The ECMO patient samples treated with lyophilized platelets demonstrated
no increase in platelet maximum force (median value of 193.3 v 39.7 nN; p = 0.18); however, there was a significant increase in platelet thrombus
area (median value of 0.13 v 0.05; p = 0.04).
Conclusions
Recombinant vWF and lyophilized platelets may help to restore primary hemostasis in
ECMO patients. Future studies should further evaluate the safety and efficacy of these
potential therapeutics in ECMO patients.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiothoracic and Vascular AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- ECLS Registry Report, International Summary.ELSO, 2022 (Available at) (Accessed December 22, 2022)
- Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: A meta-analysis of 1,866 adult patients.Ann Thorac Surg. 2014; 97: 610-616
- Bleeding, transfusion, and mortality on extracorporeal life support: ECLS Working Group on Thrombosis and Hemostasis.Ann Thorac Surg. 2016; 101: 682-689
- Acquired von Willebrand syndrome and impaired platelet function during venovenous extracorporeal membrane oxygenation: Rapid onset and fast recovery.J Heart Lung Transplant. 2018; 37: 985-991
- Thrombocytopenia and extracorporeal membrane oxygenation in adults with acute respiratory failure: A cohort study.Intensive Care Med. 2016; 42: 844-852
- Quantitative characterization of shear-induced platelet receptor shedding: Glycoprotein ibalpha, glycoprotein VI, and glycoprotein IIb/IIIa.ASAIO J. 2018; 64: 773-778
- Von Willebrand Factor-GP1balpha interactions in venoarterial extracorporeal membrane oxygenation patients.J Cardiothorac Vasc Anesth. 2019; 33: 2125-2132
- Von Willebrand Factor concentrate administration for acquired von Willebrand Syndrome- related bleeding during adult extracorporeal membrane oxygenation.J Cardiothorac Vasc Anesth. 2021; 35: 882-887
- In vitro comparison of recombinant and plasma-derived von Willebrand Factor concentrate for treatment of acquired von Willebrand syndrome in adult extracorporeal membrane oxygenation patients.Anesth Analg. 2022; 134: 312-321
- Extracorporeal membrane oxygenation induces short-term loss of high-molecular-weight von Willebrand factor multimers.Anesth Analg. 2015; 120: 730-736
- The effect of shear stress on the size, structure, and function of human von Willebrand factor.Artif Organs. 2014; 38: 741-750
- Contractile forces in platelet aggregates under microfluidic shear gradients reflect platelet inhibition and bleeding risk.Nat Commun. 2019; 10: 1204
- Evaluation of a lyophilized platelet-derived hemostatic product.Transfusion. 2019; 59: 1490-1498
- Freeze-dried platelets are a promising alternative in bleeding thrombocytopenic patients with hematological malignancies.Am J Hematol. 2022; 97: 256-266
- Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: A 5-year cohort study.Crit Care. 2013; 17: R73
- Predictive factors of bleeding events in adults undergoing extracorporeal membrane oxygenation.Ann Intensive Care. 2016; 6: 97
- Impact of massive blood transfusion during adult extracorporeal membrane oxygenation support on long-term outcomes: A nationwide cohort study in Taiwan.BMJ Open. 2020; 10e035486
- Prospective observational study of hemostatic alterations during adult extracorporeal membrane oxygenation (ECMO) using point-of-care thromboelastometry and platelet aggregometry.J Cardiothorac Vasc Anesth. 2015; 29: 288-296
- Hemostasis, coagulation and thrombin in venoarterial and venovenous extracorporeal membrane oxygenation: The HECTIC study.Sci Rep. 2021; 11: 7975
- Platelet function during extracorporeal membrane oxygenation in adult patients.Front Cardiovasc Med. 2019; 6: 114
- Shear-induced platelet receptor shedding by non-physiological high shear stress with short exposure time: Glycoprotein Ibalpha and glycoprotein VI.Thromb Res. 2015; 135: 692-698
- ATP augments von Willebrand factor-dependent shear-induced platelet aggregation through Ca2+-calmodulin and myosin light chain kinase activation.J Biol Chem. 2004; 279: 26266-26273
Article info
Publication history
Published online: December 29, 2022
Publication stage
In Press Corrected ProofFootnotes
The study was funded by a Society of Cardiovascular Anesthesiologists mid-career grant (awarded to M.M.). The lyophilized platelets used in the study were funded/provided by Cellphire Corporation at no cost.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
