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Increased Clotting in Severe COVID-19 Patients Complicates ECMO Treatment

ITHACA, N.Y., May 01, 2020 (GLOBE NEWSWIRE) -- The authors of a new publication in the Journal of Thrombosis and Hematology identify Covid-19 coagulopathy as a hallmark sign of the disease’s severity. They found that 71.4% of patients who died of the disease met disseminated intravascular coagulation (DIC) criteria, a condition that affects the body’s clotting capability. Additionally, the study identifies these patients as having predominately pro-thrombotic DIC with high venous thromboembolism rates. Doctors are utilizing heparin and tissue plasminogen activator (tPA) for anticoagulation in hopes of eliminating or reducing the number of clots. The mechanism of how the virus causes blood clots remains uncertain. Physicians continue to collect information and share experiences to improve outcomes and patient care throughout this pandemic. 

However, more official testing needs to be performed to better understand treatment options.

Extracorporeal Membrane Oxygenation (ECMO) is one therapy utilized to treat the sickest Covid-19 patients. It is standard practice for ECMO patients to be systemically anticoagulated to eliminate clots within the ECMO circuit. However, Covid-19 patients are proving difficult to manage. For example, to date, eight Covid-19 patients have been supported with ECMO at Maastricht University Medical Center in Maastricht, Netherlands. All eight have been difficult to fully anticoagulate and limit the clot burden within the ECMO circuit. The clinical perfusionists at Maastricht University Medical Center, explained that their team routinely uses the Transonic’s ELSA Monitor to assess clotting within the oxygenator, the lungs of the ECMO system.

Transonic’s ELSA Monitor quantifies clot burden within the oxygenator with a small volume saline injection. Early detection and trending of clot formation provides a wider window of opportunity to perform oxygenator change-outs. In this group of patients, whose clotting factors are harshly abnormal, the ELSA adds valuable trending measures to warn clinicians of the need for possible oxygenator change-out. On a current patient, the ECMO team at Maastricht University Medical Center is preparing for an ECMO circuit change-out for the 5th time, which is considerably higher than is customary for non-Covid-19 ECMO patients.

[1] Wang J, Hajizadeh N, Moore EE, et al. Tissue Plasminogen Activator (tPA) Treatment for COVID-19 Associated Acute Respiratory Distress Syndrome (ARDS): A Case Series [published online ahead of print, 2020 Apr 8]. J Thromb Haemost. 2020;10.1111/jth.14828. doi:10.1111/jth.14828.

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Sierra Coyle, MS, RRT-NPS


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