• Factor VIII and Functional Protein C Activity in Critically Ill Patients With Coronavirus Disease 2019: A Case Series

      Tabatabai, A.; Rabin, J.; Menaker, J.; Madathil, R.; Galvagno, S.; Menne, A.; Chow, J.H.; Herr, D.; Tanaka, K.; Scalea, T.; et al. (Wolters Kluwer Health, 2020)
      Critically ill patients with coronavirus disease 2019 (COVID-19) have been observed to be hypercoagulable, but the mechanisms for this remain poorly described. Factor VIII is a procoagulant factor that increases during inflammation and is cleaved by activated protein C. To our knowledge, there is only 1 prior study of factor VIII and functional protein C activity in critically ill patients with COVID-19. Here, we present a case series of 10 critically ill patients with COVID-19 who had severe elevations in factor VIII activity and low normal functional protein C activity, which may have contributed to hypercoagulability.
    • High-efficiency, high-flux in-line hemofiltration using a high blood flow extracorporeal circuit

      Grazioli, A.; Rabin, J.; Madathil, R.J.; King, J.D.; DiChiacchio, L.; Rector, R.P.; Deatrick, K.B.; Wu, Z.J.; Herr, D.L. (SAGE Publications Ltd, 2019)
      The ability of current renal replacement therapy modalities to achieve rapid solute removal is limited by membrane surface area and blood flow rate. Extracorporeal membrane oxygenation offers high blood flow and hemodynamic support that may be harnessed to overcome limitations in traditional renal replacement therapy. Using an extracorporeal membrane oxygenation circuit, we describe a high blood flow, high-efficiency hemofiltration technique using in-line hemofilters (hemoconcentrators) and standard replacement fluid to enhance solute clearance. Using this approach and a total of 5 L of replacement volume per treatment, creatinine (Cr) clearances of 8.3 L/hour and 11.2 L/hour using one and two hemoconcentrators, respectively, were achieved. With use of a high blood flow rate of up to 5 L/min, this hemofiltration technique can potentially offer clearance of 30 times that of continuous renal replacement therapy and of 6 times that of hemodialysis which may expand the ability to remove substances traditionally not considered removable via existing extracorporeal therapies. Copyright The Author(s) 2019.
    • Thromboelastometry and D-Dimer Elevation in Coronavirus-2019

      Madathil, R.J.; Tabatabai, A.; Rabin, J.; Menne, A.R.; Henderson, R.; Mazzeffi, M.; Scalea, T.M.; Tanaka, K. (W.B. Saunders, 2020)