Heparin-free after 3000 IU heparin loaded in veno-venous ECMO supported acute respiratory failure patients with hemorrhage risk: a novel anti-coagulation strategy

Abstract

Background The anti-coagulation protocol of patients with hemorrhage risk primary disease who need extracorporeal membrane oxygenation (ECMO) supported is controversial. This study evaluated the feasibility of a new anti-coagulation strategy, that is heparin-free after 3000 IU heparin loaded in veno-venous ECMO (VV ECMO) supported acute respiratory failure patients with hemorrhage risk. Methods A retrospective study was performed in a series of hemorrhage risk patients supported with VV ECMO at the First Affiliated Hospital of Zhengzhou University, between June 2012 to Sept 2020. A total of 70 patients received a low heparin bolus of 3000 units for cannulation but without subsequent, ongoing heparin administration. Patients were divided into survival (n = 25) and non-survival group (n = 45). Data of coagulation, hemolysis and membrane lung function were calculated and analyzed. The complications of patients were recorded. Finally, the binary Logistic regression was conducted. Results The longest heparin-free time was 216 h, and the mean heparin-free time was 102 h. Compared with survivors, the non-survivors were showed higher baseline SOFA score and lower platelet counts in 0.5 h, 24 h, 48 h and 96 h after ECMO applied. However, there was no significant differences between survivors and non-survivors in ACT, APTT, INR, D-dimer, fibrinogen, LDH, blood flow rate, Δp and Ppost-MLO2 (all p < 0.05) of all different time point. Moreover, only the baseline SOFA score was significantly associated with mortality (p < 0.001, OR(95%CI): 2.754 (1.486–5.103)) while the baseline levels of ACT, APTT, INR, platelet, D-dimer, fibrinogen and LDH have no association with mortality. The percentage of thrombosis complications was 54.3% (38/70) including 3 oxygenator changed but there was no significant difference of complications in survival and non-survival groups (p > 0.05). Conclusions The anticoagulation protocol that no heparin after a 3000 units heparin bolus in VV ECMO supported acute respiratory failure patients with hemorrhage risk is feasible.

Extracorporeal life support in trauma: Indications and techniques

“…Anticoagulation at the moment of cannulation may be feasible in situations with high perceived risk of circuit thrombosis. A loading heparin dose of 3,000 units IV without continuous infusion for V-V ECLS has been shown to be safe without significant differences in coagulation parameters 11 . Indeed, our standard practice for most GE patients has been a heparin bolus of 50 units/kg IV.…”

“…A loading heparin dose of 3,000 units IV without continuous infusion for V-V ECLS has been shown to be safe without significant differences in coagulation parameters. 11 Indeed, our standard practice for most GE patients has been a heparin bolus of 50 units/kg IV. Accounting for clinical factors, such as preexisting bleeding, the bolus dose may be adjusted based on individual circumstances, and thromboelastography is recommended, especially in trauma patients where there may be more than one reason for coagulopathy (Fig.…”

Association between coagulation disorder scores and in-hospital mortality in ARF patients: a retrospective analysis from the MIMIC-IV database

“…For example, the Simplified Acute Physiology Score-II (SAPS-II) ( 7 , 8 ) has shown its ability to identify ARF patients at high risk of death. The SOFA score was reported to be significantly associated with mortality in ARF patients ( 9 ). However, neither SAPS-II nor SOFA scores are convenient metrics in clinical settings because they are too cumbersome to calculate.…”