Post-cardiotomy venovenous extracorporeal membrane oxygenation without heparinization

Area of Science:

• Cardiovascular Surgery
• Critical Care Medicine
• Extracorporeal Life Support

Background:

• Post-cardiotomy venovenous extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for severe respiratory failure.
• Heparinization is standard in ECMO but poses bleeding risks, especially in patients with pre-existing coagulopathies or undergoing reoperation.

Purpose of the Study:

• To evaluate the feasibility and outcomes of post-cardiotomy venovenous ECMO initiated without heparinization in patients with significant bleeding risks.
• To assess survival rates, complications, and changes in coagulation parameters in this specific patient cohort.

Main Methods:

• Retrospective case series of eight patients undergoing post-cardiotomy venovenous ECMO without heparinization due to serious bleeding.
• Inclusion criteria: patients with liver cirrhosis, chronic hemodialysis, redo sternotomy, or urgent surgery.
• Data collection included ECMO duration, circuit exchanges, survival, bleeding complications, and Disseminated Intravascular Coagulation (DIC) scores.

Main Results:

• Five out of eight patients (37.5%) survived and were discharged at 90 days.
• Mean ECMO duration was 14 days, with 9 circuit exchanges across all patients.
• Significant increase in DIC scores (p < 0.05) was observed, and all patients experienced bleeding complications, though pulmonary embolism was not clinically apparent. One case of pump-head thrombosis occurred.

Conclusions:

• Post-cardiotomy venovenous ECMO without heparinization can facilitate patient rescue with a reasonable survival rate in high-risk individuals.
• Despite avoiding heparin, bleeding complications remain a significant concern.
• Further research into refined management protocols for heparin-free ECMO is warranted to optimize outcomes and minimize complications.