Blood management for adult ECMO/ECLS patients
Extracorporeal Membrane Oxygenation: Types, Medical Uses and Complications, NOVA Publications , ss.169-194, 2020
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2020
- Yayınevi: NOVA Publications
- Sayfa Sayıları: ss.169-194
- Anahtar Kelimeler: Extracorporeal life support, Extracorporeal membrane oxygenation, Patient blood management
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Extracorporeal membrane oxygenation/Extracorporeal life support (ECMO/ECLS) use is growing in adults with cardiopulmonary failure. ECMO/ECLS typically requires multiple blood transfusions and is associated with frequent bleeding complications. Blood transfusions are known to increase morbidity and mortality in critically ill patients, which may extend to patients receiving ECMO/ECLS. Aiming to reduce transfusion requirements, implementation of a blood conservation protocol is becoming more popular and mandatory. There are no high quality randomized controlled trials (RCT) to guide transfusion strategies or anticoagulation. Recent studies offer some insight into the coagulation changes that occur during the procedure, optimal anticoagulation practices, and potential therapies for bleeding. Patient blood managenet (PBM) has been defined as “the timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis and minimize blood loss to improve patient outcomes. PBM for adult ECMO/ECLS patients should be grounded in an understanding of the coagulation changes that occur during the procedure and transfusion practices. During the next decade, PBM for ECMO/ECLS will continue to mature as multi-center RCTs are completed, providing higher-level evidence. This chapter provides a framework for contemporary PBM strategies in adult ECMO/ECLS patients based on our own practice and literature.