This report details the outcomes of four patients supported by extracorporeal membrane oxygenation (ECMO) who required thoracotomy. All four patients sustained massive bleeding as a result of the operative intervention, which was not controllable in three of the patients who subsequently died. This experience has led us to review the literature of anticoagulation management of patients on ECMO so we can alter our own protocols and allow safer operative intervention in the future. Perfusion (2007) 22, 23-26.
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References
1.
Vazquez WD, Cheu HWHemorrhagic complications and repair of congenital diaphragmatic hernias: does timing of the repair make a difference? Data from the Extracorporeal Life Support Organization. J Pediatr Surg1994; 29: 1002-5.
2.
Conrad SA, Rycus PT, Dalton H.Extracorporeal life support registry report 2004. ASAIO Journal2005; 51: 4-10.
3.
Plotz FB, van Oeveren W., Bartlett RH, Wildevuur CRBlood activation during neonatal extracorporeal life support. J Thorac Cardiovasc Surg1993; 105: 823-32.
4.
Robinson TM, Kickler TS, Walker LK, Ness P., Bell W.Effect of extracorporeal membrane oxygenation on platelets in newborns. Crit Care Med1993; 21: 1029-34.
5.
Stallion A., Cofer B., Rafferty JA, Qiegler MM, Ryckman FCThe significant relationship between platelet count and haemorrhagic complications on ECMO. Perfusion1994; 9: 265-69.
6.
Thelin S., Bagge L., Hultman J. et al. Heparin-coated cardiopulmonary bypass circuits reduce blood cell trauma. Experiments in the pigs. Eur J Cardiothorac Surg1991; 4: 486-91.
7.
Videm V., Svennevig JL, Fosse E. et al. Reduced complement activation with heparin-coated oxygenator and tubings in coronary bypass operations. J Thorac Cardiovasc Surg1992; 103: 806-12.
8.
Borowiec J., Thelin S., Bagge L. et al. Heparin-coated circuits reduce activation of granulocytes during cardiopulmonary bypass. A clinical study. J Thorac Cardiovasc Surg1992; 104: 642-47.
9.
Reichman RT, Joyo CI, Dembitsky WP et al. Improved patient survival after cardiac arrest using a cardiopulmonary support system. Ann Thorac Surg1990; 49: 101-105.
10.
Klein MD, Shaheen KW, Whittlesey GC et al. Extracorporeal membrane oxygenation for the circulatory support of children after repair of congenital heart disease. J Thorac Cardiovasc Surg1990; 100: 498-505.
11.
Knoch M., Kollen B., Dietrich G., Muller E., Mottaghy K., Lennartz H.Progress in veno-venous long-term bypass techniques for the treatment of ARDS . Int J Artif Organs1992; 15: 103-108.
12.
Muehrcke DD , McCarthy PM, Stewart RW et al. Complications of extracorporeal life support systems using heparin-bound surfaces. The risk of intracardiac clot formation. J Thorac Cardiovasc Surg1995; 110: 843-51.
13.
Glauber M., Szefner J., Senni M. et al. Reduction of haemorrhagic complications during mechanically assisted circulation with the use of a multi-system anticoagulation protocol . Int J Artif Organs1995; 18: 649-55.
14.
Downard CD, Betit P., Chang RW, Garza JJ, Arnold JH, Wilson JMImpact of AMICAR on hemorrhagic complications of ECMO: a ten-year review. J Pediatr Surg2003; 38: 1212-16.
15.
Horwitz JR, Cofer BR, Warner BW, Cheu HW, Lally KPA multicentre trial of 6-aminocaproic acid (Amicar) in the prevention of bleeding in infants on ECMO. J Pediatr Surg1988; 33: 1610-13.
16.
Brunet F., Mira JP, Belghith M. et al. Effects of aprotinin on hemorrhagic complications in ARDS patients during prolonged extracorporeal CO2 removal. Intensive Care Med1992; 18: 364-67.
17.
van der Staak FH, de Haan AF, Geven WB, Festen C.Surgical repair of congenital diaphragmatic hernia during extracorporeal membrane oxygenation: hemorrhagic complications and the effect of tranexamic acid. J Pediatr Surg1997; 32: 594-99.
18.
Rossaint R. , Slama K., Lewandowski K. et al. Extracorporeal lung assist with heparin-coated systems. Int J Artif Organs1992; 15: 29-34.
19.
Landis RC, Asimakopoulos G., Poullis M. et al. Effect of aprotinin (Trasylol) on the inflammatory and thrombotic complications of conventional cardiopulmonary bypass surgery. Heart Surg Forum2000; 4: S35-39.
