Oxygenator salvage with low-dose thrombolysis. Case report

Area of Science:

• Cardiovascular Sciences
• Biomedical Engineering
• Critical Care Medicine

Background:

• Extracorporeal membrane oxygenation (ECMO) requires frequent membrane oxygenator exchanges, posing challenges in resource-limited settings due to disposable costs.
• Oxygenator thrombosis is a common complication during ECMO, necessitating timely intervention to maintain device function and patient stability.

Purpose of the Study:

• To evaluate the efficacy of low-dose recombinant tissue plasminogen activator (rt-PA) instillation as a salvage strategy for thrombosed ECMO oxygenators.
• To assess the feasibility of postponing oxygenator exchange in resource-limited healthcare systems using rt-PA.

Main Methods:

• A case study of a 48-year-old female patient on veno-venous ECMO for hypoxemic respiratory failure due to pneumonia.
• Administration of 10 mg of rt-PA directly into the premembrane port of the thrombosed oxygenator.
• Monitoring of transmembrane pressure gradient and oxygenation parameters before and after rt-PA administration.

Main Results:

• Oxygenator thrombosis was indicated by a transmembrane pressure gradient of 229 mmHg.
• Following rt-PA instillation, the transmembrane pressure gradient decreased to 116 mmHg within 60 minutes.
• Improved oxygenation was observed, and the patient was successfully weaned from ECMO without bleeding complications.

Conclusions:

• Low-dose rt-PA instillation into a failing ECMO oxygenator is a viable strategy to postpone exchange.
• This approach offers a cost-effective salvage option for ECMO programs in resource-limited environments.
• Successful management of oxygenator thrombosis with rt-PA can prevent premature device replacement and improve patient outcomes.