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ECMO without heparin: laboratory and clinical experience.
G C Whittlesey1, D E Drucker, S O Salley
1Department of Surgery, Wayne State University, Detroit, MI.
Journal of Pediatric Surgery
|March 1, 1991
Summary
Discontinuing heparin during extracorporeal membrane oxygenation (ECMO) may be feasible for patients with severe hemorrhage. This approach showed acceptable outcomes in lambs and patients, reducing bleeding without causing thrombosis.
Area of Science:
- Cardiovascular research
- Critical care medicine
- Biomedical engineering
Background:
- Extracorporeal membrane oxygenation (ECMO) typically requires heparin anticoagulation.
- Managing bleeding complications in ECMO patients is challenging.
- Investigating heparin-free ECMO is crucial for patient safety.
Observation:
- Lambs on ECMO without heparin showed no histological thrombosis.
- Heparin-free ECMO in lambs resulted in lower fibrinogen and platelet counts, but within acceptable ranges.
- Human patients on ECMO experiencing severe hemorrhage tolerated heparin discontinuation.
Findings:
- Lambs receiving heparin had significantly higher activated clotting times (ACT), prothrombin time, and partial thromboplastin time compared to the heparin-free group.
- The heparin-free group in lambs exhibited significantly lower fibrinogen levels (75 +/- 35 mg/dL) versus the heparin group (219 +/- 64 mg/dL).
- In human patients, heparin discontinuation for severe hemorrhage reduced ACT from 220 +/- 23 to 144 +/- 22 seconds, decreasing blood loss.
Implications:
- Discontinuing heparin during ECMO may be a viable strategy for managing life-threatening hemorrhage.
- This approach could improve survival rates in critically ill patients requiring ECMO.
- Further research into heparin-free ECMO protocols is warranted to optimize patient outcomes.