{"id":30984,"date":"2026-09-26T04:33:00","date_gmt":"2026-09-25T20:33:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=30984"},"modified":"2026-09-26T05:59:24","modified_gmt":"2026-09-25T21:59:24","slug":"icu-management-practice-%e4%bd%93%e5%a4%96%e7%94%9f%e5%91%bd%e6%94%af%e6%8c%81%e4%b8%8e%e6%ad%a2%e8%a1%80%e8%b0%83%e6%8e%a7","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=30984","title":{"rendered":"[ICU Management &#038; Practice]: \u4f53\u5916\u751f\u547d\u652f\u6301\u4e0e\u6b62\u8840\u8c03\u63a7"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\">Extracorporeal Life Support and Modification of Haemostasis<\/h1>\n\n\n\n<ul>\n<li>In&nbsp;<a href=\"https:\/\/healthmanagement.org\/c\/icu\">ICU<\/a><\/li>\n\n\n\n<li>Thu, 14 May 2026<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/res.cloudinary.com\/healthmanagement-org\/image\/upload\/f_auto\/q_90\/fl_lossy\/v1778756458\/cw\/00132617_cw_image_admin_5cac278c0e19605344c3a15eec452f90.webp?_a=BAAABnBs\" alt=\"\"\/><\/figure>\n\n\n\n<p>The ELMOH (ExtracorporeaL life support and Modification Of Hemostasis) trial investigated how coagulation changes during the first 48 hours of extracorporeal membrane oxygenation (ECMO) and whether these changes differ between venovenous (VV) and venoarterial (VA) ECMO. ECMO is increasingly used in critically ill patients with severe respiratory or circulatory failure, but it poses a constant challenge: anticoagulation is necessary to prevent thrombosis in the extracorporeal circuit, yet this increases the risk of bleeding. The study characterises early haemostatic alterations using both conventional laboratory tests and rotational thromboelastometry (ROTEM), and relates these findings to bleeding and transfusion requirements.<\/p>\n\n\n\n<p>This study was conducted in four tertiary intensive care units in Belgium between March 2021 and January 2023. Adults aged 18 years or older who were expected to commence VV- or VA-ECMO within two hours were eligible. A convenience sample of approximately 20 patients in each ECMO group was planned. Blood samples were collected immediately before cannulation and then at 2, 24 and 48 hours after ECMO initiation. The investigators measured activated partial thromboplastin time (aPTT), prothrombin time (PT), international normalised ratio (INR), fibrinogen, platelet count, anti-factor Xa activity, antithrombin, D-dimers and inflammatory markers such as C-reactive protein (CRP). ROTEM assays (EXTEM, INTEM, FIBTEM, HEPTEM and APTEM) were performed to assess clot initiation, formation and firmness. Bleeding was classified using both the Bleeding Academic Research Consortium (BARC) and GUSTO criteria, and transfusion requirements were documented.<\/p>\n\n\n\n<p>A total of 43 patients were included: 23 received VV-ECMO and 20 received VA-ECMO. The VV group consisted primarily of patients with severe respiratory failure, most commonly COVID-19 pneumonia, whereas the VA group mainly included patients with cardiogenic shock or extracorporeal cardiopulmonary resuscitation (ECPR). VA-ECMO patients were more severely ill at baseline, with higher SOFA scores and more frequent sepsis-induced coagulopathy.<\/p>\n\n\n\n<p>The primary outcome was thrombocytopenia, defined as a platelet count below 150 \u00d7 10\u2079\/L. At inclusion, 30% of patients were already thrombocytopenic. Overall, thrombocytopenia developed in 56% during the first 48 hours, with most cases being moderate (50\u201399 \u00d7 10\u2079\/L). Platelet counts declined significantly in both groups, but were consistently lower in VA-ECMO patients. Median platelet counts at baseline were 292 \u00d7 10\u2079\/L in the VV group compared with 145 \u00d7 10\u2079\/L in the VA group. By 24 hours, thrombocytopenia was present in 80% of VA patients and 35% of VV patients.<\/p>\n\n\n\n<p>Other coagulation markers also differed markedly between the groups. Fibrinogen concentrations were significantly higher in VV-ECMO patients at all time points, reflecting the intense inflammatory response associated with severe respiratory failure. In contrast, VA-ECMO patients had lower fibrinogen levels, prolonged INR and aPTT, and higher anti-Xa activity early after cannulation. Anti-Xa and aPTT values gradually decreased over 48 hours. CRP levels were initially higher in VV-ECMO patients but rose significantly in the VA group after ECMO initiation. Haemoglobin concentrations decreased significantly in both groups, likely due in part to haemodilution.<\/p>\n\n\n\n<p>ROTEM revealed striking differences in clot dynamics. VV-ECMO patients demonstrated a relatively hypercoagulable pattern, with shorter clot formation times and persistently high clot firmness (A10 and maximum clot firmness). Their coagulation profile remained stable throughout the study period. By contrast, VA-ECMO patients were initially hypocoagulable, with prolonged clotting and clot formation times and reduced clot strength, indicating impaired haemostasis. These abnormalities improved over 48 hours, with ROTEM values returning towards normal. Four VA patients exhibited complete clot lysis, suggesting hyperfibrinolysis and severe systemic hypoperfusion.<\/p>\n\n\n\n<p>Bleeding complications were common. Sixteen patients (37.2%) experienced clinically relevant bleeding defined as BARC score \u22652. The incidence was higher in VA-ECMO patients (55%) than in VV-ECMO patients (21.7%). Using GUSTO criteria, moderate or severe bleeding occurred in 21% overall, again more frequently in the VA group (35% versus 8.7%). Although between-group differences did not reach statistical significance in all analyses, the trend clearly indicated a greater bleeding tendency in VA-ECMO patients.<\/p>\n\n\n\n<p>Transfusions were required in 58.1% of all patients, with similar overall rates between VV and VA groups. Packed red blood cells were the most commonly administered product. Fresh frozen plasma was given exclusively to VA-ECMO patients, reflecting their more pronounced coagulopathy. Platelet and fibrinogen transfusions were uncommon. Importantly, no circuit thrombosis occurred during the first 48 hours in either group.<\/p>\n\n\n\n<p>Survival outcomes were better in VV-ECMO patients. ECMO weaning was achieved in 87% of VV patients compared with 70% of VA patients. One-year survival was 87% in the VV group and 60% in the VA group. Bleeding was associated with worse outcomes: half of the patients who experienced significant bleeding died in the intensive care unit, compared with only 11% of those without bleeding.<\/p>\n\n\n\n<p>Overall, findings show that haemostatic profiles during the first 48 hours of ECMO differ substantially according to ECMO configuration and underlying disease. VA-ECMO patients exhibit lower platelet counts, more pronounced coagulopathy and higher bleeding rates, whereas VV-ECMO patients maintain a relatively hypercoagulable state. Many of these differences are present before cannulation, indicating that baseline illness severity plays a major role. The findings support individualised haemostatic monitoring and tailored anticoagulation strategies, particularly in VA-ECMO patients, to minimise bleeding and optimise outcomes.<\/p>\n\n\n\n<p>Source:&nbsp;<a href=\"https:\/\/link.springer.com\/article\/10.1186\/s13054-026-06014-9\" target=\"_blank\" rel=\"noreferrer noopener\">Critical Care<\/a><br \/>Image Credit: iStock<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Extracorporeal Life Support and Modification of Haemost [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30984"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=30984"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30984\/revisions"}],"predecessor-version":[{"id":30985,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30984\/revisions\/30985"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=30984"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=30984"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=30984"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}