Pathology findings in nonsurvivors of veno-venous extracorporeal membrane oxygenation treatment

master's thesis

• Title (croatian): Patohistološki nalazi u pacijenata umrlih tijekom liječenja veno-venskom ekstrakorporealnom membranskom oksigenacijom
• Author: Armin Atić
• Mentor: Marko Kutleša (mentor)
• Committee member: Marko Kutleša (predsjednik povjerenstva)
• Committee member: Marija Santini (član povjerenstva)
• Committee member: Goran Tešović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Infectious Diseases); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Infectology

Abstract

ECMO is a life-support intervention allowing for oxygenation of blood independent of the function of lungs and/or heart. Developed and enhanced for decades, its use has peaked in the previous decade, particularly with the 2009 H1N1 pandemics. Invasive procedures involving severely ill patients carry a large risk of complications, which have to be weighed when choosing to perform the procedure. Majority of complications are related to the delicate coagulation status, with procoagulant and anticoagulant effects in interplay at the same time. Monitoring of anticoagulation during ECMO is difficult, and many different tests are required to paint the full coagulation status picture. Despite the array of tests available, no test is available to predict bleeding complications and adequately guide anticoagulation therapy during treatment. Hemorrhagic complications ranging in severity are the most common, and they greatly influence treatment length and mortality in VV ECMO patients. Case series presented in this thesis depicts patients in which hemorrhage was only diagnosed at autopsy, and serves as a reminder to include severe hemorrhage in the differential diagnosis in deteriorating patients on VV ECMO support.

Abstract (croatian)

ECMO je intervencija koja omogućuje oksigenaciju krvi neovisno o funkciji pluća i/ili srca. Razvijana i poboljšavana desetljećima, uporaba ECMO tehnologije je dosegla svoj vrhunac u prethodnom desetljeću, naročito tijekom H1N1 pandemije. Invazivne procedure, naročito u teško bolesnih pacijenata, nose visok rizik komplikacija na koje treba misliti tijekom donošenja odluke za vršenje procedure. Većina komplikacija je vezana za delikatni koagulacijski status jer su zbog naravi bolesti i procedure prokoagulantni i antikoagulantni učinci u stalnom međudjelovanju. Praćenje stanja koagulacije tijekom ECMO-a je komplicirano i potrebni su brojni testovi kako bi se prikazala cijela slika koagulacijskog stanja. Unatoč širokom izboru testova, niti jedan test se nije pokazao savršenim za predviđanje i procjenu krvarenja te precizno navođenje antikoagulacijske terapije. Komplikacije u vidu krvarenja svih stupnjeva su najčešće, a značajne su jer znatno utječu na duljinu liječenja i stopu smrtnih ishoda. Prikaz serije u ovom radu sadrži pacijente kod kojih je krvarenje dijagnosticirano tek na autopsiji i služi kao podsjetnik da se ozbiljno krvarenje uvijek treba naći u diferencijalnoj dijagnozi kod naglog pogoršanja stanja u pacijenata na VV ECMO potpori.

• Keywords: ECMO; ARDS; pulmonary hemorrhage; anticoagulation
• Keywords (croatian): ECMO; ARDS; plućno krvarenje; antikoagulacija
• Language: english
• URN:NBN: urn:nbn:hr:105:843949
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2020-07-20 11:11:58