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- Title
The role of inflammation and antithrombin supplementation on thromboelastographic parameters during veno-venous ECMO for respiratory failure.
- Authors
Meli, Andrea; De Falco, Stefano; Novembrino, Cristina; Anzoletti, Massimo Boscolo; Arcadipane, Antonio; Panarello, Giovanna; Occhipinti, Giovanna; Grasselli, Giacomo; Panigada, Mauro
- Abstract
Introduction: Extracorporeal membrane oxygenation (ECMO) may act as a driver or propagator of systemic inflammation. In turn, cytokine release can modify thromboelastographic (TEG) tests which are commonly used for anticoagulation monitoring. In this context, antithrombin (AT) supplementation might further modify TEG. Methods: This is a pre-specified sub-study of the “Randomized Controlled Trial of Antithrombin Supplementation During Extracorporeal Membrane Oxygenation” study (investigator-initiated, randomized, single-blind, two-arm trial) conducted in two Italian ECMO referral ICUs. Adult patients requiring vv-ECMO for respiratory failure and undergoing unfractioned heparin (UFH) administration were enrolled and randomized whether to receive AT supplementation. Plasma samples for cytokine assay (IL-8, IL-10, IL-6, IL-1β, TNF-α and Pro-ADM) and heparinase TEG were collected from every patient before ECMO start, 24 h and 72 h after ECMO start, before ECMO removal, and 7 days after ECMO removal or upon ICU discharge whichever happened first. AT concentration, coagulation and clinical data were collected before ECMO start and at pre-fixed time points. Results: Thirty-nine patients were enrolled (21 treatments, 18 controls). TEG-R had a weak-to-moderate positive correlation with IL-8, IL-6, IL-10 and TNF-α and a moderate positive correlation with Pro-ADM. TEG-ANG showed a weak negative correlation with IL-8, IL-6 and TNF-α, while TEG-MA negatively correlated with IL-8, TNF-α and Pro-ADM. AT supplementation seemed to modify the association between TEG-MA and IL-8, IL-10 and Pro-ADM; conversely, AT did not affect the relationship among TEG-R or TEG-ANG and the studied cytokines. Conclusions: High concentrations of systemic cytokines correlated with longer reaction times and decreased angle and amplitude at TEG, suggesting that an increase in inflammation is related with hypocoagulability as revealed by thromboelastography.
- Subjects
ITALY; ANTICOAGULANTS; FLUOROIMMUNOASSAY; STATISTICAL correlation; EXTRACORPOREAL membrane oxygenation; THROMBELASTOGRAPHY; CRITICALLY ill; PATIENTS; RESEARCH funding; DATA analysis; FIBRIN; RESPIRATORY insufficiency; HEPARIN; STATISTICAL sampling; LYASES; MANN Whitney U Test; CHI-squared test; DESCRIPTIVE statistics; RANDOMIZED controlled trials; DRUG efficacy; INTENSIVE care units; STATISTICS; INFLAMMATION; BLOOD coagulation; COMPARATIVE studies; DATA analysis software; INTERLEUKINS; TUMOR necrosis factors; BIOMARKERS; REGRESSION analysis
- Publication
Perfusion, 2024, Vol 39, p66S
- ISSN
0267-6591
- Publication type
Article
- DOI
10.1177/02676591241237637