Key result
Changing the ECLS circuit and oxygenator in a patient with severe thrombocytopenia led to a spontaneous increase and normalization of platelet count within 3 days.
Why the study?
Hemostatic complications such as persisting thrombocytopenia and platelet dysfunction during ECLS are multifactorial, incompletely characterized, and major causes of morbidity and mortality.
Does changing the ECLS circuit and oxygenator improve thrombocytopenia in patients on ECLS?
Case Report (n=1)
No
Does changing the ECLS circuit and oxygenator improve thrombocytopenia in patients on ECLS?
Changing the ECLS circuit and oxygenator can reverse severe thrombocytopenia and consumptive coagulopathy caused by circuit wear and thrombus deposition.
Answers are grounded in this paper and cite their sources.
May resolve circuit-related thrombocytopenia in ECLS; hypothesis-generating, requiring controlled trials before practice change.
Extracorporeal life support (ECLS) is increasingly used as a rescue therapy in patients with refractory cardiac/respiratory failure for temporary support or bridge to decision-making in both adult and pediatric patients. Complications such as bleeding and thrombosis remain major causes of morbidity and mortality in patients treated with ECLS. Hemostatic complications related to ECLS are multifactorial in patients with multiple organ dysfunctions and are incompletely characterized. Persisting thrombocytopenia and/or platelet dysfunction is the most frequent one. Herein, we report the case of a patient who developed severe thrombocytopenia after 5 days of ECLS associated with thrombi deposition in the circuit and oxygenator. After ECLS circuit and membrane change, we observed an increase and normalization in platelet count in 3 days. We propose a case-based reasoning to manage thrombocytopenia with ECLS.
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Koeltz et al. (2018) conducted a case report in Cardiogenic shock requiring ECLS complicated by severe thrombocytopenia (n=1). ECLS circuit and oxygenator change was evaluated on Platelet count recovery. Changing the ECLS circuit and oxygenator in a patient with severe thrombocytopenia led to a spontaneous increase and normalization of platelet count within 3 days.
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