Koagulacijski poremećaji kod bolesnika s ugrađenim sustavom za izvantjelesnu membransku oksigenaciju

master's thesis

• Title (english): Coagulation management in extracorporeal membrane oxygenation patients
• Author: Irma Stilinović
• Mentor: Sanja Konosić (mentor)
• Committee member: Slobodan Mihaljević (predsjednik povjerenstva)
• Committee member: Dinko Tonković (član povjerenstva)
• Committee member: Sanja Konosić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Sustav za izvantjelesnu membransku oksigenaciju (ECMO, eng. Extracorporeal membrane oxygenation) primjenjuje se u medicini već više od pola stoljeća. Njegova uloga je održavanje izmjene plinova i cirkulacije krvi do oporavka pluća i/ili srca. Metoda izvantjelesnog krvotoka originalno je zamišljena kao kardiopulmonalna premosnica (CPB, eng. Cardiopulmonary bypass), uređaj koji omogućuje perfuziju organa za vrijeme operativnih zahvata na srcu. Uz nekoliko izmjena u tehnologiji, sustav se prilagodio korištenju u dužim vremenskim periodima u jedinicama za intenzivno liječenje (JIL). U početku je metoda najviše uspjeha postizala u liječenju novorođenčadi sa zatajenjem dišnog sustava koji bi uz pomoć ECMO-a premostili period do oporavka. U odrasloj se populaciji značajniji porast korištenja bilježi tek nedavno u pandemijama H1N1 gripe 2009. godine i trenutno aktualnoj SARS-CoV-2. Bez obzira na dugu povijest u primjeni i brojne napretke, izvantjelesna oksigenacija krvi je i dalje vrlo složen postupak s čestim komplikacijama, stoga se njeno korištenje razmatra samo kada je procijenjeni mortalitet pacijenta uz primjenu konvencionalne terapije veći od 50 %, a smatra se da je svakako indicirana kada je on veći od 80 %. Među vodećim uzrocima neželjenih ishoda ECMO-a prevladavaju upravo koagulacijski poremećaji. Naime, krv postaje hiperkoagulabilna u kontaktu s bionekompatibilnim membranama ECMO-a jer se gubi normalna antikoagulantna aktivnost endotela čija je funkcija održavanje krvi u tekućem stanju u fiziološkim uvjetima. Trenutno je najveći izazov postići ravnotežu između i zadovoljavajućeg stupnja antikoaguliranosti kako bi se izbjegli česti neželjeni ishodi krvarenja iz nativne cirkulacije i tromboze u izvantjelesnoj. Oblaganje dodirne površine raznim tvarima kako bi ona što više nalikovala djelovanju endotela i primjena antikoagulantne terapije uz praćenje laboratorijskim pretragama, pokušaji su prevencije komplikacija uzrokovanih poremećajima zgrušavanja, no još uvijek ne postoji zadovoljavajuće rješenje.

Abstract (english)

Extracorporeal oxygenation has been used in medicine for almost seven decades. It is suitable as a bridging method which allows normal blood oxygenation and circulation while the heart and lungs heal. ECMO originates from the cardiopulmonary bypass, a machine used in cardiothoracic surgery, which allows adequate perfusion of organs while the heart is stopped and operated on. At first, it was somewhat difficult to adapt the procedure for use in longer time frames outside of the operating theatre. However, extracorporeal oxygenation proved to be extremely useful in treating newborns with respiratory distress. The use of ECMO in adult medicine experienced a lot more setbacks in the beginning and has only recently been widely adopted. Its beneficial effect has been mostly used as a bridging method in the treatment of severe acute respiratory distress syndrome caused by the H1N1 influenza virus and SARS-CoV-2. Extracorporeal oxygenation, despite its many advances in technology, still causes many complications. Due to the high complication rate, ECMO should be used only as salvage therapy for patients with extremely poor prognosis. It should be considered when the patient’s predicted mortality while treated with conservative therapy is greater than 50 %. Extracorporeal oxygenation is indicated if the predicted mortality reaches 80 %. Complications are most often caused by the coagulation disorders. Hemostasis is affected by the interaction of blood with artificial surfaces which makes it hypercoagulable. On the other hand, endothelium has many anticoagulant properties. The imbalance of these effects usually leads to severe hemorrhage from the native circulation or thromboembolic events in the ECMO circuit. Patients undergoing ECMO have to be closely monitored and treated with anticoagulants to prevent complications. However, the adequate solution has not yet been discovered.

• Keywords: ECMO; hemostaza; koagulacijski poremećaji; antikoagulantna terapija
• Keywords (english): ECMO; hemostasis; coagulation disorders; anticoagulants
• Language: croatian
• URN:NBN: urn:nbn:hr:105:928206
• Study programme: Title: Medicine; 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: 2023-02-28 09:55:32