초록접수 현황
| 16F-243 | 구연 발표 |
Heparin-free Extracorporeal Membrane Oxygenation in Patients with Ongoing Bleeding or Bleeding Tendency.
Sung Kwang Lee, Bong Soo Son, Mi Hee Lim, Do Hyung Kim
Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Gyeongsangnam-do, Korea
Background : Patients with severe ongoing bleeding or bleeding tendency is often seen as a contraindication to ECMO because systemic anticoagulation is generally required to maintain circuit patency. The purpose of this study is to evaluate heparin free ECMO in a condition for which anticoagulation is typically contraindicated
Methods : Patients > 18 years of age who received heparin free ECMO support between January 2012 and june 2016 were included. Patients were excluded if they stopped heparin due to over dose heparin infusion (aPTT>100sec). We retrospectively reviewed the clinical results of heparin free ECMO
Results : The causes of non-heparin ECMO were surgical ongoing bleeding 24 (42.9%) patients, medical ongoing bleeding 15 (26.8%) patients, pre or post major operation 12 (21.4%) patients, pre-procedure 4 (7.1%) patients and, others 1 (1.8%) patient. Whole or partial period heparin free ECMO was 30 (53.6%) patients, 26 (46.4%) patients respectively. The mean duration of ECMO was 237.4 ± 273.4 hours (range: 4-1508). The mean duration of heparin free ECMO was 101.3 ± 146.6 hours (range: 3-679). 34 (60.7%) patients were maintained without heparin for more than 1 day. 25 (44.6%) Patients were possible to stop bleeding during heparin free ECMO, 6 (10.7%) patients were died due to failure of bleeding. Incidence of clinically meaningful thrombo-embolic event was 14 (25%) patients, however the exchange rate of oxygenator were 11 (19.6%) patients, it is lower than conventional ECMO (20.6%) in our institute. The number of ECMO weaning, ICU discharge and hospital discharge is 29 (51.8%), 25 (44.6%) and 25 (44.6%), respectively.
Conclusion : Generally, ECMO is considered contraindication in patients with severe ongoing bleeding or bleeding tendency. Occurrence of thrombo-embolism and associated life-threatening situations in heparin-free ECMO was not higher than conventional ECMO. In high risk bleeding, ongoing bleeding, para-operative patient, heparin-free ECMO may be considered the option of ECMO in selected patients.
Methods : Patients > 18 years of age who received heparin free ECMO support between January 2012 and june 2016 were included. Patients were excluded if they stopped heparin due to over dose heparin infusion (aPTT>100sec). We retrospectively reviewed the clinical results of heparin free ECMO
Results : The causes of non-heparin ECMO were surgical ongoing bleeding 24 (42.9%) patients, medical ongoing bleeding 15 (26.8%) patients, pre or post major operation 12 (21.4%) patients, pre-procedure 4 (7.1%) patients and, others 1 (1.8%) patient. Whole or partial period heparin free ECMO was 30 (53.6%) patients, 26 (46.4%) patients respectively. The mean duration of ECMO was 237.4 ± 273.4 hours (range: 4-1508). The mean duration of heparin free ECMO was 101.3 ± 146.6 hours (range: 3-679). 34 (60.7%) patients were maintained without heparin for more than 1 day. 25 (44.6%) Patients were possible to stop bleeding during heparin free ECMO, 6 (10.7%) patients were died due to failure of bleeding. Incidence of clinically meaningful thrombo-embolic event was 14 (25%) patients, however the exchange rate of oxygenator were 11 (19.6%) patients, it is lower than conventional ECMO (20.6%) in our institute. The number of ECMO weaning, ICU discharge and hospital discharge is 29 (51.8%), 25 (44.6%) and 25 (44.6%), respectively.
Conclusion : Generally, ECMO is considered contraindication in patients with severe ongoing bleeding or bleeding tendency. Occurrence of thrombo-embolism and associated life-threatening situations in heparin-free ECMO was not higher than conventional ECMO. In high risk bleeding, ongoing bleeding, para-operative patient, heparin-free ECMO may be considered the option of ECMO in selected patients.
책임저자: Do Hyung Kim
Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Gyeongsangnam-do, Korea
발표자: Sung Kwang Lee, E-mail : drlsk@naver.com