Is 300 Seconds ACT Safe and Efficient during MiECC Procedures?

Autor: Michal Szlapka, H Hausmann, Martin Scharpenberg, Adrian Bauer, J. Michael Hasenkam, Thomas Eberle, Jan Schaarschmidt
Rok vydání: 2017
Předmět:
Male
Pulmonary and Respiratory Medicine
Time Factors
Whole Blood Coagulation Time
Oxygenators
Membrane oxygenator
Activated clotting time
030204 cardiovascular system & hematology
law.invention
03 medical and health sciences
Extracorporeal Membrane Oxygenation
0302 clinical medicine
Predictive Value of Tests
Risk Factors
law
Germany
Thromboembolism
Journal Article
medicine
Cardiopulmonary bypass
Humans
Minimally Invasive Surgical Procedures
Protamines
Coronary Artery Bypass
Blood Coagulation
Aged
Cardiopulmonary Bypass
medicine.diagnostic_test
biology
Heparin
business.industry
Extracorporeal circulation
Anticoagulants
Heparin Antagonists
Middle Aged
Protamine
Surface coating
Treatment Outcome
030228 respiratory system
Anesthesia
biology.protein
Feasibility Studies
Female
Surgery
Cardiology and Cardiovascular Medicine
business
medicine.drug
Zdroj: Bauer, A, Hausmann, H, Schaarschmidt, J, Szlapka, M, Scharpenberg, M, Eberle, T & Hasenkam, J M 2019, ' Is 300 Seconds ACT Safe and Efficient during MiECC Procedures? ', The Thoracic and Cardiovascular Surgeon, vol. 67, no. 3, pp. 191-202 . https://doi.org/10.1055/s-0037-1609019
ISSN: 1439-1902
0171-6425
Popis: Introduction The recommended minimum activated clotting time (ACT) level for cardiopulmonary bypass (CPB) of 480 seconds originated from investigations with bubble oxygenators and uncoated extracorporeal circulation (ECC) systems. Modern minimal invasive ECC (MiECC) systems are completely closed circuits containing a membrane oxygenator and a tip-to-tip surface coating. We hypothesized that surface coating and the “closed-loop” design allow the MiECC to safely run with lower ACT levels and that an ACT level of 300 seconds can be safely applied without thromboembolic complications. The aim of this study was to investigate the potential risks during application of reduced heparin levels in patients undergoing coronary surgery. Methods In this study, 68 patients undergoing coronary artery bypass grafting with MiECC were randomized to either the study group with an ACT target of 300 seconds or the control group with an ACT of 450 seconds. All other factors of MiECC remained unchanged. Results The study group received significantly less heparin and protamine (heparin [international units] median [min–max], Red_AC: 32,800 [23,000–51,500] vs. Full_AC: 50,000 [35,000–65,000] p Conclusion Since no evidence of increased thrombin formation (ETP) was found from a laboratory standpoint, we concluded that the use of MiECC with a reduced anticoagulation strategy seems possible. This alternative anticoagulation strategy leads to significant reduction in dosages of both heparin and protamine. We can confidently move forward with investigating this anticoagulation concept. However, to establish clinical safety of ACT below 300 seconds, we need larger clinical studies.
Databáze: OpenAIRE
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