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dc.contributor.authorKi, Katrina K
dc.contributor.authorPassmore, Margaret R
dc.contributor.authorChan, Chris HH
dc.contributor.authorMalfertheiner, Maximilian
dc.contributor.authorFanning, Jonathon P
dc.contributor.authorBouquet, Mahe
dc.contributor.authorMillar, Jonathan E
dc.contributor.authorFraser, John F
dc.contributor.authorSuen, Jacky Y
dc.date.accessioned2019-12-02T07:01:23Z
dc.date.available2019-12-02T07:01:23Z
dc.date.issued2019
dc.identifier.issn2197-425X
dc.identifier.doi10.1186/s40635-019-0264-z
dc.identifier.urihttp://hdl.handle.net/10072/389455
dc.description.abstractBACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a life-saving modality used to manage cardiopulmonary failure refractory to conventional medical and surgical therapies. Despite advances in ECMO equipment, bleeding and thrombosis remain significant complications. While the flow rate for ECMO support is well recognized, less is known about the minimum-rate requirements and haemostasis. We investigated the relationship between different ECMO flow rates, and their effect on haemolysis and coagulation. METHODS: Ten ex-vivo ECMO circuits were tested using donated, < 24-h-old human whole blood, with two flow rates: high-flow at 4 L/min (normal adult cardiac output; n = 5) and low-flow at 1.5 L/min (weaning; n = 5). Serial blood samples were taken for analysis of haemolysis, von Willebrand factor (vWF) multimers by immunoblotting, rotational thromboelastometry, platelet aggregometry, flow cytometry and routine coagulation laboratory tests. RESULTS: Low-flow rates increased haemolysis after 2 h (p = 0.02), 4 h (p = 0.02) and 6 h (p = 0.02) and the loss of high-molecular-weight vWF multimers (p = 0.01), while reducing ristocetin-induced platelet aggregation (p = 0.0002). Additionally, clot formation times were prolonged (p = 0.006), with a corresponding decrease in maximum clot firmness (p = 0.006). CONCLUSIONS: In an ex-vivo model of ECMO, low-flow rate (1.5 L/min) altered haemostatic parameters compared to high-flow (4 L/min). Observed differences in haemolysis, ristocetin-induced platelet aggregation, high-molecular-weight vWF multimers and clot formation time suggest an increased risk of bleeding complications. Since patients are often on ECMO for protracted periods, extended-duration studies are required to characterise long-term ECMO-induced haemostatic changes.
dc.description.peerreviewedYes
dc.languageEnglish
dc.publisherSpringer Open
dc.relation.ispartofpagefrom51:1
dc.relation.ispartofpageto51:15
dc.relation.ispartofissue1
dc.relation.ispartofjournalIntensive Care Medicine Experimental
dc.relation.ispartofvolume7
dc.subject.keywordsScience & Technology
dc.subject.keywordsLife Sciences & Biomedicine
dc.subject.keywordsCritical Care Medicine
dc.subject.keywordsGeneral & Internal Medicine
dc.subject.keywordsCoagulation
dc.titleLow flow rate alters haemostatic parameters in an ex-vivo extracorporeal membrane oxygenation circuit
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationKi, KK; Passmore, MR; Chan, CHH; Malfertheiner, M; Fanning, JP; Bouquet, M; Millar, JE; Fraser, JF; Suen, JY, Low flow rate alters haemostatic parameters in an ex-vivo extracorporeal membrane oxygenation circuit, Intensive Care Medicine Experimental, 2019, 7 (1), pp. 51:1-51:15
dcterms.dateAccepted2019-08-12
dcterms.licensehttp://creativecommons.org/licenses/by/4.0/
dc.date.updated2019-12-02T06:33:09Z
dc.description.versionPublished
gro.rights.copyright© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
gro.hasfulltextFull Text
gro.griffith.authorFraser, John F.
gro.griffith.authorChan, Hoi Houng


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