Feasibility of Venovenous Extracorporeal Membrane Oxygenation Without Systemic Anticoagulation
Feasibility of Venovenous Extracorporeal Membrane Oxygenation Without Systemic Anticoagulation
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DOI：
10.1016/j.athoracsur.2020.02.011
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发表时间：
2020-10-01
影响因子：
4.6
通讯作者：
Bharat, Ankit
中科院分区：
文献类型：
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作者：
Kurihara, Chitaru;Walter, James M.;Bharat, Ankit
背景资料。静脉体外膜氧合(ECMO)越来越多地被用于急性呼吸窘迫综合征，并被用作肺移植的桥梁。静脉-静脉ECMO开始后，传统的全身抗凝治疗可导致出血。在这里，我们研究了静脉静脉ECMO是否可以在没有持续全身抗凝的情况下用于急性呼吸窘迫综合征患者。这是对一个机构ECMO数据库的回顾。我们纳入了从2015年1月到2019年2月的连续患者。总体而言，38名患者接受了低水平的持续全身抗凝(AC+)，而随后的36名患者接受了标准静脉血栓预防(AC-)。已发表的体外生命支持组织指南被用于定义结果和并发症。总体而言，两组患者的存活率没有差异(P=.58)。然而，AC+组患者胃肠道出血的发生率较高(28.9%，AC-组5.6%；P<；.001)。AC组患者每天胃肠道出血的发生率为0.00025，AC+组为0.00064(P<；.001)。此外，AC+组的氧合功能障碍增加(28.9%和0.00067个病人日事件，而AC-11.1%和0.00062个病人日事件；P=0.02)。此外，AC+组输注更多的红细胞：AC+组94.7%对AC-组55.5%(P&t；.001)；新鲜冰冻血浆AC+60.5%对AC-16.6%(P=.001)；血小板AC+84.2%对AC-27.7%(P<；.001)。在ECMO支持的整个过程中，两组均未发生电路血栓形成。我们的结果表明，静脉静脉ECMO可以安全地应用，而不需要持续的全身抗凝治疗。这种方法可能与减少出血质量和输血需求有关。(C)2020年，由胸外科医生学会主办
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. (C) 2020 by The Society of Thoracic Surgeons