TY - JOUR
T1 - Feasibility of Venovenous Extracorporeal Membrane Oxygenation Without Systemic Anticoagulation
AU - Kurihara, Chitaru
AU - Walter, James M.
AU - Karim, Azad
AU - Thakkar, Sanket
AU - Saine, Mark
AU - Odell, David D.
AU - Kim, Samuel
AU - Tomic, Rade
AU - Wunderink, Richard G.
AU - Budinger, G. R.Scott
AU - Bharat, Ankit
N1 - Funding Information:
AB is supported by National Institutes of Health HL125940 , HL145478 , HL147290 , and HL147575 . The authors would like to thank Ms Elena Susan for administrative assistance in the submission of this manuscript.
Publisher Copyright:
© 2020 The Society of Thoracic Surgeons
PY - 2020/10
Y1 - 2020/10
N2 - Background: Venovenous extracorporeal membrane oxygenation (ECMO) is increasingly being used for acute respiratory distress syndrome and as a bridge to lung transplantation. After initiation of venovenous ECMO, systemic anticoagulation therapy is traditionally administered and can cause bleeding diathesis. Here, we investigated whether venovenous ECMO can be administered without continuous systemic anticoagulation administration for patients with acute respiratory distress syndrome. Methods: This is a retrospective review of an institutional ECMO database. We included consecutive patients from January 2015 through February 2019. Overall, 38 patients received low levels of continuous systemic anticoagulation (AC+) whereas the subsequent 36 patients received standard venous thromboprophylaxis (AC−). Published Extracorporeal Life Support Organization guidelines were used for the definition of outcomes and complications. Results: Overall, survival was not different between the two groups (P = .58). However, patients in the AC+ group had higher rates of gastrointestinal bleeding (28.9%, vs AC− group 5.6%; P < .001). The events per patient-day of gastrointestinal bleeding was 0.00025 in the AC− group and 0.00064 in the AC+ group (P < .001). In addition, oxygenator dysfunction was increased in the AC+ group (28.9% and 0.00067 events per patient-day, vs AC− 11.1% and 0.00062 events per patient-day; P = .02). Furthermore, the AC+ group received more transfusions: packed red blood cells, AC+ group 94.7% vs AC− group 55.5% (P < .001); fresh frozen plasma, AC+ 60.5% vs AC− 16.6% (P = .001); and platelets, AC+ 84.2% vs AC− 27.7% (P < .001). There was no circuit thrombosis in either groups throughout the duration of ECMO support. Conclusions: Our results suggest that venovenous ECMO can be safely administered without continuous systemic anticoagulation therapy. This approach may be associated with reduced bleeding diathesis and need for blood transfusions.
AB - Background: Venovenous extracorporeal membrane oxygenation (ECMO) is increasingly being used for acute respiratory distress syndrome and as a bridge to lung transplantation. After initiation of venovenous ECMO, systemic anticoagulation therapy is traditionally administered and can cause bleeding diathesis. Here, we investigated whether venovenous ECMO can be administered without continuous systemic anticoagulation administration for patients with acute respiratory distress syndrome. Methods: This is a retrospective review of an institutional ECMO database. We included consecutive patients from January 2015 through February 2019. Overall, 38 patients received low levels of continuous systemic anticoagulation (AC+) whereas the subsequent 36 patients received standard venous thromboprophylaxis (AC−). Published Extracorporeal Life Support Organization guidelines were used for the definition of outcomes and complications. Results: Overall, survival was not different between the two groups (P = .58). However, patients in the AC+ group had higher rates of gastrointestinal bleeding (28.9%, vs AC− group 5.6%; P < .001). The events per patient-day of gastrointestinal bleeding was 0.00025 in the AC− group and 0.00064 in the AC+ group (P < .001). In addition, oxygenator dysfunction was increased in the AC+ group (28.9% and 0.00067 events per patient-day, vs AC− 11.1% and 0.00062 events per patient-day; P = .02). Furthermore, the AC+ group received more transfusions: packed red blood cells, AC+ group 94.7% vs AC− group 55.5% (P < .001); fresh frozen plasma, AC+ 60.5% vs AC− 16.6% (P = .001); and platelets, AC+ 84.2% vs AC− 27.7% (P < .001). There was no circuit thrombosis in either groups throughout the duration of ECMO support. Conclusions: Our results suggest that venovenous ECMO can be safely administered without continuous systemic anticoagulation therapy. This approach may be associated with reduced bleeding diathesis and need for blood transfusions.
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U2 - 10.1016/j.athoracsur.2020.02.011
DO - 10.1016/j.athoracsur.2020.02.011
M3 - Article
C2 - 32173339
AN - SCOPUS:85084967639
SN - 0003-4975
VL - 110
SP - 1209
EP - 1215
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 4
ER -