Factor XIII Activity Might Already Be Impaired before Veno-Venous ECMO in ARDS Patients: A Prospective, Observational Single-Center Cohort Study.

Onnen Moerer,Joern Schaeper,Saskia Wand,Jan Felix Huber-Petersen,Claudia Binder

doi:10.3390/jcm10061203

Abstract

Direct complications in patients receiving extracorporeal (veno-venous) membrane oxygenation (vvECMO) are mainly either due to bleeding or thromboembolism. We aimed to evaluate the course of routine coagulation parameters and the activity of different coagulation factors—with special focus on factor XIII (F XIII)—before, during and after vvECMO in acute respiratory distress syndrome (ARDS) patients. The activity of coagulation factors and rotational thrombelastometry were analyzed in 20 ECMO patients before (T-1) and 6 h (T0), one (T1), three (T3) and seven days (T7) after the implantation, as well as one and three days after the termination of ECMO. F XIII activity was already severely decreased to 37% (30/49) before ECMO. F XIII activity was the only coagulation factor continuously declining during vvECMO, being significantly decreased at T3 (31% (26/45) vs. 24% (18/42), p = 0.0079) and T7 (31% (26/45) vs. 23% (17/37), p = 0.0037) compared to T0. Three days after termination of vvECMO, platelet count and fibrinogen nearly doubled and factors II, V, XI and XIII showed spontaneous significant increases. Severe ARDS patients showed a considerably diminished factor XIII activity before vvECMO initiation and its activity continuously declined later on. Thus, incorporation of F XIII monitoring into the regular hemostaseologic routine during vvECMO therapy seems advisable. Due to the potential development of a hypercoagulatory state after the termination of vvECMO, tight hemostasiologic monitoring should persist in the initial phase after ECMO termination.

Highlights

Extracorporeal Membrane Oxygenation (ECMO) has evolved to a widely applied rescue therapy for patients with severe acute hypoxemic respiratory failure, which is refractory to conventional therapy [1,2,3]
The results of the present study indicate that the kinetics of factor XIII (F XIII) activity under veno-venous extracorporeal membrane oxygenation (vvECMO) therapy differ completely from all other evaluated coagulation factors
The activity of F XIII in patients receiving vvECMO therapy is already considerably diminished before the initiation of extracorporeal circulation

Summary

Introduction

Extracorporeal Membrane Oxygenation (ECMO) has evolved to a widely applied rescue therapy for patients with severe acute hypoxemic respiratory failure, which is refractory to conventional therapy [1,2,3]. Systemic anticoagulation therapy is unavoidable as a therapeutic measure in order to prevent clot formation during extracorporeal circulation [1,2,3]. This adds an additional risk of bleeding, since the coagulation system of the critically ill might be already impaired before the initiation of ECMO due to the underlying disease [11]. Bleeding events during the course of treatment are frequent and might lead to premature termination of the technique or have a critical impact on outcome [15,16]

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