Extracorporeal carbon dioxide removal performed with surface‐heparinized equipment in patients with ARDS

Abstract

To avoid the drawbacks of systemic anticoagulation during prolonged extracorporeal circulation in patients with adult respiratory distress syndrome (ARDS) a heparinization technique has been developed by which partially degraded heparin can be covalently end-point attached to the surface of the equipment constituting the extracorporeal circuit (Carmeda Bio-Active Surface, CBAS) thereby localizing the anticoagulatory effert. Since 1986 we have used extracorporeal circuits and membrane lungs coated with the CBAS for extracorporeal lung assistance (ECLA) in 14 patients suffering from ARDS. The patients were on ECLA for 3 to 55 days with a survival rate of43%. Our experience so far is that by using equipment coated with CBAS it is possible to perform long-term extracorporeal circulation with a minimum of intravenously administered heparin, thus avoiding the risk of major coagulation defects.

Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review

“…Following removal of duplicates ( n  = 9), removal of those not meeting screening eligibility criteria ( n  = 118) and full-text exclusions ( n  = 6; see Additional file 3), 14 studies were included in this review (two RCTs and 12 observational studies) [18-31]. …”

“…In total, 14 studies were included: two RCTs (Table 1) [18,19], and six prospective observational studies [20-25] and six retrospective studies [26-31] (Table 2). The earliest study dated from 1986 and the most recent from 2013.…”

High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation

“…As a consequence, a longer duration of extracorporeal respiratory support (23 vs 9 days in the Morris et al trial), fewer blood product requirements and the performance of major surgical procedures during ECMO became possible. The heparin-coated membrane lungs, however, had to be changed frequently due to plasma leakage [85][86][87][88][89], exposing the patient to the risks of such maneuvers. Other authors using ECMO with heparinized equipment have also reported prolonged extracorporeal perfusion times without major bleeding complications [79,80].…”

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“…In 1987, Bindslev et al [42] reported the first long-term application of a surface-heparinized extracorporeal circuit in a 44-year-old woman with severe ARDS. Since that time, nearly all European ECMO centres have switched to the surface-heparinized extracorporeal circulation technique, with no or minimal systemic heparinization [10,43]. …”

“…The data support the view that survival rates in both treatment groups followed a positive trend. Data have been taken from [1,5,8,9,10,12,13,14,15,30,31,39,43,55, 56,63,64,91,92,95,96,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130]. …”