Thromboembolic Events in Patients on Extracorporeal Membrane Oxygenation Without Anticoagulation
Thromboembolic Events in Patients on Extracorporeal Membrane Oxygenation Without Anticoagulation
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DOI：
10.1097/imi.0b013e3182029a83
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发表时间：
2010-11-01
影响因子：
1.5
通讯作者：
Cheung, Anson
中科院分区：
文献类型：
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作者：
Lamarche, Yoan;Chow, Bryan;Cheung, Anson
目的：肝素化被认为是强制性的，以避免静脉动脉体外膜肺氧合（VA-ECMO）期间的血栓栓塞并发症。出血并发症很常见。我们报告我们的经验VA-ECMO无全身抗凝。方法：一个前瞻性的数据库，描述所有ECMO病例从2000年至2008年进行了分析。肝素涂覆的回路（Medtronic，Inc.，Minneapolis，MN USA）和膜式氧合器（Quadrox D Bioline氧合器; MAQUET，Rastatt，德国）。VA-ECMO支持启动后，校正了所有凝血参数。没有进一步的全身维持抗凝剂，除了在脱机的时间。结果：32例患者接受VA-ECMO支持; 20例（62.5%）是男性，中位年龄为52.5岁（四分位距，40.4-61.1岁）。中央和外周插管分别为53%和47%。心源性休克的病因为心切开术后（75%，n = 24），25%的病例（n = 8）为心肺复苏支持。30天死亡率为43.8%。ECMO支持的中位持续时间为46.3小时（四分位距，26.8-87.8小时）。输注浓缩红细胞的中位数为18 +/- 25。并发症包括5例（16%）肢体缺血需要干预，15例（46.9%）急性肾功能衰竭，2例深静脉血栓形成，2例心内血栓超声心动图检测。无患者发生脑血管事件。膜式氧合器故障的发生率较低，3例患者需要更换;更换过程中未发生不良事件。14例患者（43.8%）因出血再次探查。14例患者（44%）出院回家，是长期survivors.Conclusions：VA ECMO支持无全身抗凝可能会减少出血并发症和输血的要求，而不会增加血栓栓塞的风险。
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.