PMID- 22437638
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20121002
LR  - 20221010
IS  - 1556-9845 (Print)
IS  - 1556-9845 (Linking)
VI  - 5
IP  - 6
DP  - 2010 Nov
TI  - Thromboembolic events in patients on extracorporeal membrane oxygenation without 
      anticoagulation.
PG  - 424-9
AB  - OBJECTIVE: : Heparinization is thought to be mandatory to avoid thromboembolic 
      complications during venoarterial extracorporeal membrane oxygenation (VA-ECMO). 
      However, bleeding complications are common. We report our experience of VA-ECMO 
      without systemic anticoagulation. METHODS: : A prospectively assembled database 
      describing all ECMO cases from 2000 to 2008 was analyzed. A heparin coated 
      circuit (Medtronic, Inc., Minneapolis, MN USA) and membrane oxygenator (Quadrox D 
      Bioline oxygenator; MAQUET, Rastatt, Germany) were used in all cases. After the 
      initiation of VA-ECMO support, all coagulation parameters were corrected. No 
      further systemic maintenance anticoagulant was given, except at the time of 
      weaning. RESULTS: : Thirty-two patients received VA-ECMO support; 20 patients 
      (62.5%) were males with a median age of 52.5 years (interquartile range, 
      40.4-61.1 years). Central and peripheral cannulations were 53% and 47%, 
      respectively. Etiologies of cardiogenic shock were postcardiotomy (75%, n = 24) 
      and as a support to cardiopulmonary resuscitation in 25% of cases (n = 8). 
      Thirty-day mortality was 43.8%. Median duration of ECMO support was 46.3 hours 
      (interquartile range, 26.8-87.8 hours). The median number of packed red blood 
      cell transfusions was 18 +/- 25. Complications include five patients (16%) with 
      limb ischemia requiring intervention, 15 patients (46.9%) had acute renal 
      failure, two patients had deep vein thrombosis, and two patients had intracardiac 
      clots detected on echocardiograms. No patient had a cerebrovascular event. 
      Incidence of membrane oxygenator failure was low, requiring replacement in three 
      patients; no adverse event occurred during replacement. Fourteen patients (43.8%) 
      were reexplored for bleeding. Fourteen patients (44%) were discharged home and 
      were long-term survivors. CONCLUSIONS: : VA-ECMO support without systemic 
      anticoagulation may reduce bleeding complications and transfusion requirement, 
      without increasing the risk of thromboembolism.
FAU - Lamarche, Yoan
AU  - Lamarche Y
AD  - From the St. Paul's Hospital, Providence Health Care, University of British 
      Columbia, Vancouver, BC Canada.
FAU - Chow, Bryan
AU  - Chow B
FAU - Bedard, Annie
AU  - Bedard A
FAU - Johal, Navreet
AU  - Johal N
FAU - Kaan, Annemarie
AU  - Kaan A
FAU - Humphries, Karin H
AU  - Humphries KH
FAU - Cheung, Anson
AU  - Cheung A
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Innovations (Phila)
JT  - Innovations (Philadelphia, Pa.)
JID - 101257528
EDAT- 2010/11/01 00:00
MHDA- 2010/11/01 00:01
CRDT- 2012/03/23 06:00
PHST- 2012/03/23 06:00 [entrez]
PHST- 2010/11/01 00:00 [pubmed]
PHST- 2010/11/01 00:01 [medline]
AID - 01243895-201011000-00008 [pii]
AID - 10.1177/155698451000500608 [doi]
PST - ppublish
SO  - Innovations (Phila). 2010 Nov;5(6):424-9. doi: 10.1177/155698451000500608.