Analyse der Aktivitäten verschiedener Gerinnungsfaktoren im Verlauf unter einer venovenösen extrakorporalen Membranoxygenierung

Acute respiratory distress syndrom (ARDS) can lead to severe acute hypoxemic respiratory failure. When conventional management strategies failed veno-venous extracoporeal membrane oxygenation (vvECMO) can be a rescue therapy. But itself is associated with severe thrombembolic or hemorrhagic events. The aim of the study was to gain more information on different coagulation parameters before, during and after vvECMO in ARDS patients. The activity of coagulation factors, rotational thrombelastometry and platelet function were analyzed in 20 patients on specific time points. Platelet function was measured by multiple electrode aggregometry (Multiplate) and rotational thrombelastometry was analyzed by ROTEM. Before initiiating the vvECMO the values of aggregational measurements were below the normal range with a further decrease under therapy and recovered spontaneously with a significant increase 2 days after the beginning of vvECMO. The activity of several coagulation factors decreased after the beginning of vvECMO and recovered during the next seven days while continuing the therapy. In ARDS patients Factor XIII was severely decreased before starting the vvECMO and even declined under therapy. After termination of the vvECMO the risk of hypercoagulatory state should lead to prolonging hemostasiologic monitoring.