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Article ; Online: Bivalirudin Superiority in Pediatric Berlin Hearts: Too Early to Draw Conclusions?

Seelhammer, Troy G / Wieruszewski, Patrick M / Laudanski, Krzysztof

ASAIO journal (American Society for Artificial Internal Organs : 1992)

2023 Volume 69, Issue 11, Page(s) e467

MeSH term(s)	Humans ; Child ; Hirudins ; Antithrombins/therapeutic use ; Peptide Fragments/pharmacology ; Peptide Fragments/therapeutic use ; Recombinant Proteins/therapeutic use ; Anticoagulants ; Heparin ; Treatment Outcome
Chemical Substances	bivalirudin (TN9BEX005G) ; Hirudins ; Antithrombins ; Peptide Fragments ; Recombinant Proteins ; Anticoagulants ; Heparin (9005-49-6)
Language	English
Publishing date	2023-05-22
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	759982-1
ISSN	1538-943X ; 0162-1432 ; 1058-2916
ISSN (online)	1538-943X
ISSN	0162-1432 ; 1058-2916
DOI	10.1097/MAT.0000000000001991
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Article ; Online: Unresponsiveness of Activated Partial Thromboplastin Time to Bivalirudin in Adults Receiving Extracorporeal Membrane Oxygenation.

Jatis, Andrew J / Nei, Scott D / Seelhammer, Troy G / Mara, Kristin C / Wieruszewski, Patrick M

ASAIO journal (American Society for Artificial Internal Organs : 1992)

2024

Abstract: Activated partial thromboplastin time (aPTT) is the standard for monitoring bivalirudin but demonstrates a nonlinear response at higher drug concentrations. The objective of this study was to assess the relationship between bivalirudin dose and aPTT in ... ...

Abstract	Activated partial thromboplastin time (aPTT) is the standard for monitoring bivalirudin but demonstrates a nonlinear response at higher drug concentrations. The objective of this study was to assess the relationship between bivalirudin dose and aPTT in patients receiving extracorporeal membrane oxygenation (ECMO) to determine a threshold where aPTT unresponsiveness occurs. Two hundred fourteen adults receiving bivalirudin during ECMO between 2018 and 2022 were included. Piecewise regression in a linear mixed effects model was used to determine a bivalirudin dose threshold of 0.21 mg/kg/hr for aPTT unresponsiveness. For doses of less than 0.21 mg/kg/hr (n = 135), every 0.1 mg/kg/hr dose increase led to an aPTT increase of 11.53 (95% confidence interval [CI] = 9.85-13.20) seconds compared to only a 3.81 (95% CI = 1.55-6.06) seconds increase when dose was greater than or equal to 0.21 mg/kg/hr (n = 79) (pinteraction < 0.001). In multivariable logistic regression, venovenous configuration (odds ratio [OR] = 2.83, 95% CI = 1.38-5.77) and higher fibrinogen concentration (OR = 1.22, 95% CI = 1.05-1.42) were associated with greater odds of unresponsiveness, whereas older age (OR = 0.79, 95% CI = 0.63-0.98), kidney dysfunction (OR = 0.48, 95% CI = 0.25-0.92), and a higher baseline aPTT (OR = 0.89, 95% CI = 0.82-0.97) were associated with lower odds. Alternative methods are necessary to ascertain bivalirudin's hemostatic impact when doses exceed 0.21 mg/kg/hr during ECMO.
Language	English
Publishing date	2024-02-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	759982-1
ISSN	1538-943X ; 0162-1432 ; 1058-2916
ISSN (online)	1538-943X
ISSN	0162-1432 ; 1058-2916
DOI	10.1097/MAT.0000000000002172
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Article ; Online: Antithrombin Replacement and Extracorporeal Membrane Oxygenation: The time is ripe for a Simpler Solution.

Seelhammer, Troy G / Hamzah, Mohammed / Wieruszewski, Patrick

ASAIO journal (American Society for Artificial Internal Organs : 1992)

2022 Volume 68, Issue 10, Page(s) e166–e167

MeSH term(s)	Anticoagulants ; Antithrombin III ; Antithrombins ; Extracorporeal Membrane Oxygenation ; Retrospective Studies
Chemical Substances	Anticoagulants ; Antithrombins ; Antithrombin III (9000-94-6)
Language	English
Publishing date	2022-03-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	759982-1
ISSN	1538-943X ; 0162-1432 ; 1058-2916
ISSN (online)	1538-943X
ISSN	0162-1432 ; 1058-2916
DOI	10.1097/MAT.0000000000001704
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Article ; Online: Extracorporeal Membrane Oxygenation in Acute Respiratory Failure.

Wieruszewski, Patrick M / Ortoleva, Jamel P / Cormican, Daniel S / Seelhammer, Troy G

Pulmonary therapy

2023 Volume 9, Issue 1, Page(s) 109–126

Abstract: ... ECMO (e.g., recovery, transplantation, etc.), are critical to successful ECMO support. In this review ...

Abstract	Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is a form of mechanical life support that provides full respiratory bypass in patients with severe respiratory failure as a bridge to recovery or lung transplantation. The use of ECMO for respiratory failure and capable centers offering ECMO has expanded over the years, increasing its availability. As VV-ECMO provides an artificial mechanism for oxygenation and decarboxylation of native blood, it allows for an environment in which safer mechanical ventilatory care may be provided, allowing for treatment and resolution of underlying respiratory pathologies. Landmark clinical trials have provided a framework for better understanding patient selection criteria, resource utilization, and outcomes associated with ECMO when applied in settings of refractory respiratory failure. Maintaining close vigilance and management of complications during ECMO as well as identifying strategies post-ECMO (e.g., recovery, transplantation, etc.), are critical to successful ECMO support. In this review, we examine considerations for candidate selection for VV-ECMO, review the evidence of utilizing VV-ECMO in respiratory failure, and provide practical considerations for managing respiratory ECMO patients, including complication identification and management, as well as assessing for the ability to separate from ECMO support and the procedures for decannulation.
Language	English
Publishing date	2023-01-21
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2364-1746
ISSN (online)	2364-1746
DOI	10.1007/s41030-023-00214-2
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Article ; Online: Analysis of Wholesale Drug Acquisition and Laboratory Assessment Costs Between Heparin Compared With Bivalirudin-Based Systemic Anticoagulation Strategies in Adult Extracorporeal Membrane Oxygenation.

Seelhammer, Troy G / Brokmeier, Hannah M / Hamzah, Mohammed / Wieruszewski, Patrick M

Critical care medicine

2023 Volume 51, Issue 5, Page(s) e115–e121

Abstract: Objectives: To assess the wholistic costs of systemic anticoagulation delivery in heparin versus bivalirudin-based maintenance of adult patients supported on extracorporeal membrane oxygenation (ECMO).: Design: Single-center retrospective cohort ... ...

Abstract	Objectives: To assess the wholistic costs of systemic anticoagulation delivery in heparin versus bivalirudin-based maintenance of adult patients supported on extracorporeal membrane oxygenation (ECMO). Design: Single-center retrospective cohort study. Setting: Large academic ECMO center. Patients: Adults on ECMO receiving heparin or bivalirudin for primary maintenance systemic anticoagulation. Interventions: None. Measurements and main results: Electronic data were abstracted from a database maintained by our ECMO center, which transitioned to a preferred bivalirudin-based anticoagulation management in 2017. The pretransition group consisted of 126 patients (123 heparin and three bivalirudin), whereas the posttransition group included 275 patients (82 heparin and 193 bivalirudin). Drug costs were estimated using the wholesale acquisition cost, and laboratory assays costs were estimated using reimbursement fee schedules. Cost data were normalized to the duration of the ECMO run and reported in U.S. Dollar per ECMO day. Following the practice change, bivalirudin patients were less likely to receive AT supplementation (31.0 vs 12.4%; p < 0.0001) and had fewer coagulation assays ordered (6.1 vs 5.4 per ECMO day; p = 0.0004). After the transition, there was a dramatic decrease in costs related to AT assay assessments ($11.78 [interquartile range {IQR}, $9.48-$13.09] vs $1.03 [IQR, $0-$5.75]; p < 0.0001) and AT supplementation ($0 [IQR, $0-$312.82] vs $0 [IQR, $0-$0]; p < 0.0001) per ECMO day. Unadjusted survival at 28 days was higher posttransition (64.3 vs 74.9%; p = 0.0286). Conclusions: Antithrombin assays and supplementation compromise a significant proportion of heparin-based anticoagulation costs in ECMO patients and is substantially reduced when a bivalirudin-based anticoagulation strategy is deployed. A favorable association exists between the aggregate cost of administration of bivalirudin compared with heparin-based systemic anticoagulation in adults supported on ECMO driven by reductions in antithrombin activity assessments and the cost of antithrombin replacement.
MeSH term(s)	Adult ; Humans ; Heparin/therapeutic use ; Extracorporeal Membrane Oxygenation ; Retrospective Studies ; Pharmaceutical Preparations ; Anticoagulants/therapeutic use ; Hirudins ; Antithrombins/therapeutic use ; Peptide Fragments ; Recombinant Proteins/therapeutic use
Chemical Substances	Heparin (9005-49-6) ; bivalirudin (TN9BEX005G) ; Pharmaceutical Preparations ; Anticoagulants ; Hirudins ; Antithrombins ; Peptide Fragments ; Recombinant Proteins
Language	English
Publishing date	2023-02-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000005821
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Zs.A 1261: Show issues

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Article ; Online: Use of ecarin chromogenic assay during bivalirudin anticoagulation in adult extracorporeal membrane oxygenation.

Krauter, Abby K / Nei, Scott D / Seelhammer, Troy G / Bohman, J Kyle / Wieruszewski, Patrick M

Thrombosis research

2023 Volume 228, Page(s) 42–45

MeSH term(s)	Adult ; Humans ; Extracorporeal Membrane Oxygenation/adverse effects ; Hirudins/pharmacology ; Peptide Fragments/therapeutic use ; Anticoagulants/therapeutic use ; Recombinant Proteins/therapeutic use ; Heparin ; Retrospective Studies
Chemical Substances	bivalirudin (TN9BEX005G) ; ecarin (EC 3.4.24.-) ; Hirudins ; Peptide Fragments ; Anticoagulants ; Recombinant Proteins ; Heparin (9005-49-6)
Language	English
Publishing date	2023-05-29
Publishing country	United States
Document type	Letter
ZDB-ID	121852-9
ISSN	1879-2472 ; 0049-3848
ISSN (online)	1879-2472
ISSN	0049-3848
DOI	10.1016/j.thromres.2023.05.022
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Zs.A 863: Show issues

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Article ; Online: Bivalirudin in Pediatric Extracorporeal Membrane Oxygenation: Clarity or Confusion?

Seelhammer, Troy G / Bohman, John K / Nabzdyk, Christoph G S

ASAIO journal (American Society for Artificial Internal Organs : 1992)

2021 Volume 67, Issue 6, Page(s) 697–699

MeSH term(s)	Child ; Erythrocyte Transfusion ; Extracorporeal Membrane Oxygenation/adverse effects ; Hirudins ; Humans ; Peptide Fragments ; Recombinant Proteins
Chemical Substances	Hirudins ; Peptide Fragments ; Recombinant Proteins ; bivalirudin (TN9BEX005G)
Language	English
Publishing date	2021-02-02
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	759982-1
ISSN	1538-943X ; 0162-1432 ; 1058-2916
ISSN (online)	1538-943X
ISSN	0162-1432 ; 1058-2916
DOI	10.1097/MAT.0000000000001364
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Uk I Zs.199: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Cardiac tamponade in a patient supported by veno-arterial extracorporeal membrane oxygenation.

Seelhammer, Troy G / Loftsgard, Theodore O / Wittwer, Erica D / Ritter, Matthew J

Annals of cardiac anaesthesia

2022 Volume 25, Issue 2, Page(s) 204–205

Abstract: Cardiac tamponade occurring in a patient supported on central veno-arterial extracorporeal membrane oxygenation is depicted in a transesophageal echocardiography image and associated rendering. Prompt recognition of tamponade, which can be assisted with ... ...

Abstract	Cardiac tamponade occurring in a patient supported on central veno-arterial extracorporeal membrane oxygenation is depicted in a transesophageal echocardiography image and associated rendering. Prompt recognition of tamponade, which can be assisted with echocardiography, and emergent evacuation is critical to restoring cardiovascular stability.
MeSH term(s)	Cardiac Tamponade/diagnostic imaging ; Cardiac Tamponade/etiology ; Cardiac Tamponade/therapy ; Echocardiography ; Echocardiography, Transesophageal ; Extracorporeal Membrane Oxygenation/methods ; Humans
Language	English
Publishing date	2022-04-14
Publishing country	India
Document type	Journal Article
ZDB-ID	2106866-5
ISSN	0974-5181 ; 0971-9784
ISSN (online)	0974-5181
ISSN	0971-9784
DOI	10.4103/aca.aca_223_20
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Article ; Online: Cumulative epinephrine dose during cardiac arrest and neurologic outcome after extracorporeal cardiopulmonary resuscitation.

Garcia, Samuel I / Seelhammer, Troy G / Saddoughi, Sahar A / Finch, Alexander S / Park, John G / Wieruszewski, Patrick M

The American journal of emergency medicine

2024 Volume 80, Page(s) 61–66

Abstract: Background: Epinephrine is recommended without an apparent ceiling dosage during cardiac arrest. However, excessive alpha- and beta-adrenergic stimulation may contribute to unnecessarily high aortic afterload, promote post-arrest myocardial dysfunction, ...

Abstract	Background: Epinephrine is recommended without an apparent ceiling dosage during cardiac arrest. However, excessive alpha- and beta-adrenergic stimulation may contribute to unnecessarily high aortic afterload, promote post-arrest myocardial dysfunction, and result in cerebral microvascular insufficiency in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR). Methods: This was a retrospective cohort study of adults (≥ 18 years) who received ECPR at large academic ECMO center from 2018 to 2022. Patients were grouped based on the amount of epinephrine given during cardiac arrest into low (≤ 3 mg) and high (> 3 mg) groups. The primary endpoint was neurologic outcome at hospital discharge, defined by cerebral performance category (CPC). Multivariable logistic regression was used to assess the relationship between cumulative epinephrine dosage during arrest and neurologic outcome. Results: Among 51 included ECPR cases, the median age of patients was 60 years, and 55% were male. The mean cumulative epinephrine dose administered during arrest was 6.2 mg but ranged from 0 to 24 mg. There were 18 patients in the low-dose (≤ 3 mg) and 25 patients in the high-dose (> 3 mg) epinephrine groups. Favorable neurologic outcome at discharge was significantly greater in the low-dose (55%) compared to the high-dose (24%) group (p = 0.025). After adjusting for age, those who received higher doses of epinephrine during the arrest were more likely to have unfavorable neurologic outcomes at hospital discharge (odds ratio 4.6, 95% CI 1.3, 18.0, p = 0.017). Conclusion: After adjusting for age, cumulative epinephrine doses above 3 mg during cardiac arrest may be associated with unfavorable neurologic outcomes after ECPR and require further investigation.
Language	English
Publishing date	2024-03-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2024.03.013
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Zs.A 2005: Show issues

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Article ; Online: Acute kidney injury in patients before and after extracorporeal membrane oxygenation (ECMO) - Retrospective longitudinal analysis of the hospital outcomes.

Guru, Pramod K / Balasubramanian, Prasanth / Ghimire, Manoj / Bohman, J Kyle K / Seelhammer, Troy G / Kashani, Kianoush B / Schears, Gregory J

Journal of critical care

2024 Volume 81, Page(s) 154528

Abstract: Purpose: Acute Kidney Injury (AKI) occurs in up to 85% of patients managed by ECMO support. Limited data are available comparing the outcomes among patients who develop AKI before and after ECMO initiation.: Methods: A retrospective longitudinal ... ...

Abstract	Purpose: Acute Kidney Injury (AKI) occurs in up to 85% of patients managed by ECMO support. Limited data are available comparing the outcomes among patients who develop AKI before and after ECMO initiation. Methods: A retrospective longitudinal observational study was performed on all adult patients placed on ECMO from January 2000 to December 2015 at our institution. Longitudinal multivariate logistic regressional analysis was performed to identify the variables that are associated with the outcome measures (post-ECMO AKI and in-hospital mortality). Results: A total of 329 patients were included in our analysis in which AKI occurred in 176 (53%) and 137 (42%) patients before and after ECMO, respectively. In the multivariate analysis, increasing age, pre-existing chronic kidney disease (CKD), increasing bilirubin, decreasing fibrinogen, and use of LVAD had significant association with post-ECMO AKI. In-hospital mortality was seen in 128 out of 176 (73%) patients in the pre-ECMO AKI group and 32 out of 137 (42%) in the post-ECMO AKI group. In the multivariate analysis, age, interstitial lung disease, pre-ECMO AKI, and post-ECMO RRT requirement were independently associated with mortality. Conclusion: AKI before ECMO initiation and the need for RRT post-ECMO are independently associated with poor patient survival.
MeSH term(s)	Adult ; Humans ; Retrospective Studies ; Extracorporeal Membrane Oxygenation ; Acute Kidney Injury/therapy ; Outcome Assessment, Health Care ; Hospitals
Language	English
Publishing date	2024-01-31
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2024.154528
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