Rethinking Coagulation Activation during Extracorporeal Membrane Oxygenation: Insights from the Case of Mr. Hageman

Editorial| July 2024 Rethinking Coagulation Activation during Extracorporeal Membrane Oxygenation: Insights from the Case of Mr. Hageman Kenichi A. Tanaka, M.D., M.Sc.; Kenichi A. Tanaka, M.D., M.Sc. 1Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. https://orcid.org/0000-0002-5051-1365 Search for other works by this author on: This Site PubMed Google Scholar Michael A. Mazzeffi, M.D., M.P.H., M.Sc.; Michael A. Mazzeffi, M.D., M.P.H., M.Sc. 2Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia. https://orcid.org/0000-0003-2955-4915 Search for other works by this author on: This Site PubMed Google Scholar Jerrold H. Levy, M.D., F.A.H.A. Jerrold H. Levy, M.D., F.A.H.A. 3Department of Anesthesiology, Critical Care, and Surgery (Cardiothoracic), Duke University Medical Center, Durham, North Carolina. https://orcid.org/0000-0003-3766-4962 Search for other works by this author on: This Site PubMed Google Scholar Author and Article Information Accepted for publication April 3, 2024. This editorial accompanies the article on p. 75. Address correspondence to Dr. Tanaka: Anesthesiology July 2024, Vol. 141, 7–9. https://doi.org/10.1097/ALN.0000000000005003 Connected Content Article: Fibrinolysis as a Causative Mechanism for Bleeding Complications on Extracorporeal Membrane Oxygenation: A Pilot Observational Prospective Study Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Search Site Citation Kenichi A. Tanaka, Michael A. Mazzeffi, Jerrold H. Levy; Rethinking Coagulation Activation during Extracorporeal Membrane Oxygenation: Insights from the Case of Mr. Hageman. Anesthesiology 2024; 141:7–9 doi: https://doi.org/10.1097/ALN.0000000000005003 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsAnesthesiology Search Advanced Search Topics: blood coagulation, coagulation process, extracorporeal membrane oxygenation Blood surface interfacing that occurs within the extracorporeal membrane oxygenation (ECMO) circuit initiates contact activation, an important hemostatic pathway initiated by the Hageman factor, also called factor XII. Factor XII was first discovered in 1968, when Mr. Hageman, the index patient for factor XII deficiency, fractured his left hemi-pelvis after falling from a ladder.1 On the twelfth hospital day, he suffered a massive pulmonary embolism and died. These episodes and current research suggest that Hageman factor or factor XII is not essential for intravascular coagulation, but its main roles lie in other physiologic processes.2 Activated factor XII is an essential protease in the kinin–kallikrein system. When plasma is exposed to nonendothelial surfaces, like the tubing in an ECMO circuit, factor XII becomes activated, initiating kallikrein activation and subsequent cleavage of high-molecular-weight kininogen, ultimately releasing bradykinin. The role that these mediators play in thrombo-inflammatory pathways in ECMO patients remains... You do not currently have access to this content.