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Review
. 2016 Dec;48(4):162-167.

Review of Venoarterial Extracorporeal Membrane Oxygenation and Development of Intracardiac Thrombosis in Adult Cardiothoracic Patients

Brittney Williams  1 , Wendy Bernstein  1
Affiliations
Review

Review of Venoarterial Extracorporeal Membrane Oxygenation and Development of Intracardiac Thrombosis in Adult Cardiothoracic Patients

Brittney Williams et al. J Extra Corpor Technol. 2016 Dec.

Abstract

Venoarterial extracorporeal membrane oxygenation (VA ECMO) has become an indispensable treatment option for adult cardiothoracic patients experiencing acute refractory cardiogenic shock. VA ECMO is not without inherent complications as in-hospital mortality has ranged from 45% to 65% (1-3). Intracardiac thrombosis (ICT) is a rare but life-threatening complication associated with VA ECMO. VA ECMO cases complicated by ICT were searched for using the MEDLINE (PubMed and OVID), Society of Cardiovascular Anesthesiology Headquarters, and Google Scholar databases. Twelve cases of VA ECMO-associated ICT were discovered for review. Indications for VA ECMO were postcardiotomy cardiogenic shock and heart failure. The primary location of thrombus was the left ventricle and aortic root. Majority of the cases did not report subtherapeutic systemic anticoagulation. Two patients survived after the development of ICT. VA ECMO-associated ICT is a devastating consequence with high mortality. The majority of ICT occurred in cases with perceived adequate anticoagulation, but this may not result in complete suppression of the coagulation response. Continued exposure to procoagulant stimuli and worsening ventricular function and intracardiac stasis can shift the balance toward a hypercoagulable state and development of thrombosis.

Keywords: cardiothoracic; coagulation; thrombosis; venoarterial extracorporeal membrane oxygenation.

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Figures

Figure 1.
Figure 1.
Proposed pathophysiological factors involved in formation of ICT on VA ECMO. It shows the interactions of elements involved in ICT formation on VA ECMO based on Virchow's triad of creation of a prothrombotic state.
See this image and copyright information in PMC

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