1. Conclusions & Discussions
Our experience of Therapeutic Plasma Exchange in Sepsis and changes to practise.
Cara Pardoe Specialist ECMO Coordinator. Manchester University Hospital Foundation Trust.
BACCN Conference 2018
Introduction
Method
Our unit is one of five commissioned ECMO centres within the UK; Extracorporeal Oxygenation Membrane involves oxygenating the blood outside the body in order to facilitate Lung Protective Ventilation.1 Sepsis is defined as overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure, and/or death. 2.
Therapeutic Plasma Exchange (TPE) removes large molecular weight substances out of the body and replaces it with FFP/5% Human Albumin Solution. A one plasma volume removes approximately 66% of an intravascular components. 3.
The first ten patients to receive TPE whilst on ECMO had case review and a local data base is kept.
Results
Conclusions & Discussions
Out of the 10 patients reviewed,
Five where discharge home, with only minor ICU complications.
Three patients had active treatment withdrawn, 2 of these patients had Panton Valentine Leucocidin Staphylococcus Aureus the other eosinophilic pneumonia.
Two patients died off ECMO within the 90 days.
Average ECMO run time of the five patients who survived to home discharge is 435 hours NB. One of those patients had a run time of 1622; our average run time for 2017/18 is 360 hours.
There needs to be precise communications between multi-professionals to ensure the service and patient remains safe.
The checklist needs to be utilised and importance of requesting autoimmune blood tests prior to starting TPE treatment is paramount; however our current turn around for these blood tests is a challenge. The tests we request on each patient being treated with TPE include; Adamts13, anti nuclear abs, Cardiolipin antibodies, antibodies to ENA, DNA antibodies, ANCA and Rheumatoid factor.
We have a service level agreement with NHSBT to provide our TPE; referral is easy and often the TPE Nurses are with the patient within ninety minutes.
We now have a collaboration with other UK ECMO centres to collect data and publish reports.
Our ECMO mortality for 2017/18 68% and 63% hospital discharge.
Other then the one patient who survived hospital discharge having an ECMO run of 1622 the other 4 surviving patients had a much shorter ECMO run of between hours.
It is believed with the correct pathway and identifying of patients who require TPE we can reduce ECMO run times and reduce mortality/morbidity.
Zhongheng, Z. et al (2017.) Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure. Canadian Respiratory Journal. 2017:
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