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. 2020 Oct;110(4):1209-1215.
doi: 10.1016/j.athoracsur.2020.02.011. Epub 2020 Mar 12.

Feasibility of Venovenous Extracorporeal Membrane Oxygenation Without Systemic Anticoagulation

Chitaru Kurihara  1 , James M Walter  2 , Azad Karim  1 , Sanket Thakkar  1 , Mark Saine  1 , David D Odell  1 , Samuel Kim  1 , Rade Tomic  2 , Richard G Wunderink  2 , G R Scott Budinger  2 , Ankit Bharat  3
Affiliations

Feasibility of Venovenous Extracorporeal Membrane Oxygenation Without Systemic Anticoagulation

Chitaru Kurihara et al. Ann Thorac Surg. 2020 Oct.

Abstract

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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Figures

Figure 1.
Figure 1.
Survival of patients undergoing venovenous extracorporeal membrane oxygenation with (+ [red line]) and without (− [black line]) systemic anticoagulation therapy.
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