Complicanze emorragiche nell’assistenza infermieristica al paziente adulto in circolazione extracorporea: revisione della letteratura

Filippo Binda, Alessandro Lazzarini, Roberto Accardi

Abstract

I pazienti sottoposti alla circolazione extracorporea (ECMO) necessitano di elevati dosaggi di anticoagulante per il buon funzionamento del circuito e ciò li espone ad un alto rischio emorragico. Le sedi più comuni di sanguinamento sono i siti di inserzione delle cannule, la cute e le mucose. Meno frequenti, ma potenzialmente fatali sono invece i sanguinamenti maggiori (polmonari, gastrointestinali, retroperitoneali e del sistema nervoso centrale).

Riferimenti bibliografici

Shekar K, Mullany D V, Thomson B, Ziegenfuss M, Platts DG, Fraser JF. Extracorporeal life support devices and strategies for management of acute cardiorespiratory failure in adult patients: a comprehensive review. Crit Care 2014;18:219. https://doi.org/10.1186/cc13865.

Murphy DA, Hockings LE, Andrews RK, Aubron C, Gardiner EE, Pellegrino VA, et al. Extracorporeal membrane oxygenation-hemostatic complications. Transfus Med Rev 2015;29:90–101. https://doi.org/10.1016/j.tmrv.2014.12.001.

Millar JE, Fanning JP, McDonald CI, McAuley DF, Fraser JF. The inflammatory response to extracorporeal membrane oxygenation (ECMO): A review of the pathophysiology. Crit Care 2016;20. https://doi.org/10.1186/s13054-016-1570-4.

Oliver WC. Anticoagulation and coagulation management for ECMO. Semin Cardiothorac Vasc Anesth 2009;13:154–75. https://doi.org/10.1177/1089253209347384.

Olson SR, Murphree CR, Zonies D, Meyer AD, Mccarty OJT, Deloughery TG, et al. Thrombosis and Bleeding in Extracorporeal Membrane Oxygenation (ECMO) Without Anticoagulation: A Systematic Review. ASAIO J 2021;67:290–6. https://doi.org/10.1097/MAT.0000000000001230.

Lotz C, Streiber N, Roewer N, Lepper PM, Muellenbach RM, Kredel M. Therapeutic Interventions and Risk Factors of Bleeding During Extracorporeal Membrane Oxygenation. ASAIO J 2017;63:624–30. https://doi.org/10.1097/MAT.0000000000000525.

Fletcher Sandersjöö A, Bartek J, Thelin EP, Eriksson A, Elmi-Terander A, Broman M, et al. Predictors of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation: an observational cohort study. J Intensive Care 2017;5:27. https://doi.org/10.1186/s40560-017-0223-2.

Aubron C, Cheng AC, Pilcher D, Leong T, Magrin G, Cooper DJ, et al. Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: A 5-year cohort study. Crit Care 2013;17. https://doi.org/10.1186/cc12681.

Oude Lansink-Hartgring A, de Vries AJ, Droogh JM, van den Bergh WM. Hemorrhagic complications during extracorporeal membrane oxygenation – The role of anticoagulation and platelets. J Crit Care 2019;54:239–43. https://doi.org/10.1016/j.jcrc.2019.09.013.

Guidelines for Cardiopulmonary Extracorporeal Life Support. Extracorporeal Life Support Organization (ELSO), Versione 1.4. Ann Arbor, MI, USA. 2017.

Mossadegh C, Combes A. Nursing care and ECMO. Springer International Publishing; 2017. https://doi.org/10.1007/978-3-319-20101-6.

Redaelli S, Zanella A, Milan M, Isgrò S, Lucchini A, Pesenti A, et al. Daily nursing care on patients undergoing venous-venous extracorporeal membrane oxygenation: a challenging procedure! J Artif Organs 2016;19:343–9. https://doi.org/10.1007/s10047-016-0912-y.

Mazzeffi M, Kiefer J, Kon Z, Wolf J. Severe epistaxis during adult extracorporeal membrane oxygenation: not your average nosebleed. J Thorac Dis 2015;7:E564-5. https://doi.org/10.3978/j.issn.2072-1439.2015.10.34.

Kreyer S, Muders T, Theuerkauf N, Spitzhüttl J, Schellhaas T, Schewe J-C, et al. Hemorrhage under veno-venous extracorporeal membrane oxygenation in acute respiratory distress syndrome patients: a retrospective data analysis. J Thorac Dis 2017;9:5017–29. https://doi.org/10.21037/jtd.2017.11.05.

Pillai AK, Bhatti Z, Bosserman AJ, Mathew MC, Vaidehi K, Kalva SP. Management of vascular complications of extra-corporeal membrane oxygenation. Cardiovasc Diagn Ther 2018;8:372–7. https://doi.org/10.21037/cdt.2018.01.11.

Mulhall AM, Jindal SK. Massive gastrointestinal hemorrhage as a complication of the Flexi-Seal fecal management system. Am J Crit Care 2013;22:537–43. https://doi.org/10.4037/ajcc2013499.

Lucchini A, Bambi S, de Felippis C, Galazzi A, Addis G, Rona R, et al. Oral Care Protocols With Specialty Training Lead to Safe Oral Care Practices and Reduce Iatrogenic Bleeding in Extracorporeal Membrane Oxygenation Patients. Dimens Crit Care Nurs 2018;37:285–93. https://doi.org/10.1097/DCC.0000000000000321.

Clements L, Moore M, Tribble T, Blake J. Reducing skin breakdown in patients receiving extracorporeal membranous oxygenation. Nurs Clin North Am 2014;49:61–8. https://doi.org/10.1016/j.cnur.2013.11.003.

Mazzeffi M, Kiefer J, Greenwood J, Tanaka K, Menaker J, Kon Z, et al. Epidemiology of gastrointestinal bleeding in adult patients on extracorporeal life support. Intensive Care Med 2015;41:2015. https://doi.org/10.1007/s00134-015-4006-8.

Makdisi G, Wang I-W. Severe epistaxis in patients on extracorporeal membranous oxygenator support occurrence and management. J Thorac Dis 2015;7:E566-7. https://doi.org/10.3978/j.issn.2072-1439.2015.11.45.

Ried M, Sommerauer L, Lubnow M, Müller T, Philipp A, Lunz D, et al. Thoracic Bleeding Complications in Patients With Venovenous Extracorporeal Membrane Oxygenation. Ann Thorac Surg 2018;106:1668–74. https://doi.org/10.1016/j.athoracsur.2018.07.020.

Calhoun A. ECMO: Nursing Care of Adult Patients on ECMO. Crit Care Nurs Q 2018;41:394–8. https://doi.org/10.1097/CNQ.0000000000000226.

Hoffman T, Du Plessis M, Prekupec MP, Gielecki J, Zurada A, Tubbs RS, et al. Ultrasound-guided central venous catheterization: A review of the relevant anatomy, technique, complications, and anatomical variations. Clin Anat 2017;30:237–50. https://doi.org/10.1002/ca.22768.

Gravante F, Lombardi A, Gagliardi AM, Pucci A, Latina R. Dressings and Securement Devices of Peripheral Arterial Catheters in Intensive Care Units and Operating Theaters. Dimens Crit Care Nurs 2020;39:242–50. https://doi.org/10.1097/DCC.0000000000000433.

Allen S, Holena D, McCunn M, Kohl B, Sarani B. A review of the fundamental principles and evidence base in the use of extracorporeal membrane oxygenation (ECMO) in critically ill adult patients. J Intensive Care Med 2011;26:13–26. https://doi.org/10.1177/0885066610384061.

Ferrie S, Herkes R, Forrest P. Nutrition support during extracorporeal membrane oxygenation (ECMO) in adults: a retrospective audit of 86 patients. Intensive Care Med 2013;39:1989–94. https://doi.org/10.1007/s00134-013-3053-2.

MacLaren R, Jarvis CL, Fish DN. Use of Enteral Nutrition for Stress Ulcer Prophylaxis. Ann Pharmacother 2001;35:1614–23. https://doi.org/10.1345/aph.1A083.

Harrison MA, Baker AL, Roy S, Hirose H, Cavarocchi NC. Management of upper aerodigestive tract bleeding on extracorporeal membrane oxygenation. Mech Circ Support 2013;4:11826580. https://doi.org/10.3402/mcs.v4i0.20333.

Tirlapur N, Puthucheary ZA, Cooper JA, Sanders J, Coen PG, Moonesinghe SR, et al. Diarrhoea in the critically ill is common, associated with poor outcome, and rarely due to Clostridium difficile. Sci Rep 2016;6:24691. https://doi.org/10.1038/srep24691.

Binks R, De Luca E, Dierkes C, Franci A, Herrero E, Niederalt G. Prevalence, clinical consequences and management of acute faecal incontinence with diarrhoea in the ICU: The FIRSTTM Observational Study. J Intensive Care Soc 2015;16:294–301. https://doi.org/10.1177/1751143715589327.

Daniel ES, Ng A, Johnston MJ, Ong EJ. Rectal bleeding post the use of the Flexi-Seal faecal management system. ANZ J Surg 2018;88:E83–4. https://doi.org/10.1111/ans.13252.

Tayyib N, Coyer F. Effectiveness of Pressure Ulcer Prevention Strategies for Adult Patients in Intensive Care Units: A Systematic Review. Worldviews Evidence-Based Nurs 2016;13:432–44. https://doi.org/10.1111/wvn.12177.

Lucchini A, Elli S, De Felippis C, Greco C, Mulas A, Ricucci P, et al. The evaluation of nursing workload within an Italian ECMO Centre: A retrospective observational study. Intensive Crit Care Nurs 2019;55:102749. https://doi.org/10.1016/j.iccn.2019.07.008.

Refback

  • Non ci sono refbacks, per ora.