Platelet Function Disturbance During Veno-Venous ECMO in ARDS Patients Assessed by Multiple Electrode Aggregometry-A Prospective, Observational Cohort Study.

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

doi:10.3390/jcm8071056

Abstract

Extracorporeal (veno-venous) membrane oxygenation (vvECMO) has been shown to have negative effects on platelet number and function. This study aimed to gain more information about the impact of vvECMO on platelet function assessed by multiple electrode aggregometry (MEA). Twenty patients with the indication for vvECMO were included. Platelet function was analyzed using MEA (Multiplate®) before (T-1), 6 h (T0), one (T1), two (T2), three (T3), and seven (T4) days after the beginning of vvECMO. Median aggregational measurements were already below the normal reference range before vvECMO initiation. Platelet aggregation was significantly reduced 6 h after vvECMO initiation compared to T-1 and spontaneously recovered with a significant increase at T2. Platelet count dropped significantly between T-1 and T0 and continuously decreased between T0 and T4. At T4, ADP-induced platelet aggregation showed an inverse correlation with the paO2 in the oxygenator. Platelet function should be assessed by MEA before the initiation of extracorporeal circulation. Although ECMO therapy led to a further decrease in platelet aggregation after 6 h, all measurements had recovered to baseline on day two. This implies that MEA as a whole blood method might not adequately reflect the changes in platelet function in the later stages of extracorporeal circulation.

Highlights

During the observational period of seven days, seven patients showed signs of mild bleeding, one patient suffered from a severe bleeding complication on the second day of ECMO treatment
This study evaluated the effects of Veno-venous extracorporeal membrane oxygenation (vvECMO) therapy on platelet function over time and revealed a significant reduction in thrombin receptor activating peptide 6 (TRAP-6) induced platelet aggregation 6 h after the start of ECMO therapy and a spontaneous significant increase in TRAP-6 induced platelet aggregation two days after the implementation of ECMO
Platelet function assessed by multiple electrode aggregometry in patients with severe acute respiratory distress syndrome (ARDS) is already impaired before the initiation of extracorporeal circulation

Summary

Introduction

Veno-venous extracorporeal membrane oxygenation (vvECMO) is an increasingly used therapeutic option in patients with severe acute respiratory distress syndrome (ARDS), when conventional management strategies, such as adequate PEEP-setting or prone positioning, fail to secure a sufficient gas exchange [1,2,3].The concerns to apply vvECMO for less severe states of ARDS despite its benefits, e.g., in order to enhance lung protective ventilation, results from inherent and substantial complications related to the technique, which prevail despite the technical advances related to the technique of extracorporeal membrane oxygenation [2,3].ECMO therapy still imposes massive changes to the body’s normal physiology and entails the risk for severe complications [1,4,5]. Extracorporeal circulation in cardiopulmonary bypass as well as in ECMO therapy has been shown to have negative effects on platelet number and function [7,9]. The understanding has grown that monitoring of platelet function is much more important for the evaluation of a bleeding event than the mere analysis of platelet number. It is unclear to which extent results from studies using MEA to evaluate the effects of short-term extracorporeal circulation, such as cardiopulmonary bypass, on platelet function, can be extrapolated on the effects during long-term extracorporeal circulation as in vvECMO therapy [9,12]. Studies in animal models suggest that there may be an additional effect of the severe underlying disease in ARDS on platelet dysfunction assessed with MEA [13]

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