Complications of extracorporeal life support systems using heparin-bound surfaces: The risk of intracardiac clot formation
| Autor: | Delos M. Cosgrove, Robert W. Stewart, Stephanie Seshagiri, David A. Ogella, Patrick M. McCarthy, Derek D. Muehrcke, Robert C. Foster |
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| Rok vydání: | 1995 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Adolescent Heart Diseases Membrane oxygenator medicine.medical_treatment Shock Cardiogenic Extracorporeal Extracorporeal Membrane Oxygenation Ischemia Angioplasty Internal medicine Extracorporeal membrane oxygenation Humans Medicine Myocardial infarction Thrombus Child Aged Heparin business.industry Cardiogenic shock Extremities Thrombosis Middle Aged medicine.disease Surgery Life Support Care Survival Rate Logistic Models Child Preschool Shock (circulatory) Multivariate Analysis Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business Echocardiography Transesophageal |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 110:843-851 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/s0022-5223(95)70119-2 |
| Popis: | Extracorporeal life support with heparin-coated extracorporeal membrane oxygenation circuits are being used with increased frequency in patients who have cardiogenic shock. We report our experience in 30 patients with cardiogenic shock, looking specifically at the complications associated with this form of life support. Thirty patients with a mean age of 46.5 ± 16.6 years received extracorporeal life support for a mean of 62.8 ± 41.1 hours (range 0.5 to 159 hours). Twenty-three patients had postcardiotomy cardiogenic shock, five had acute myocardial infarction, and one each had acute cardiac deterioration after a balloon coronary angioplasty and another after pulmonary artery balloon angioplasty. Peripheral (femoral vein to femoral artery) cannulation was used in 24 patients. Limb ischemia developed in 21 patients (70%), renal failure in 17 patients (57%), oxygenator failure requiring change in 13 patients (43%), bleeding requiring reexploration in 12 (40%), and infection in 9 patients (30%). Transesophageal echocardiography revealed intracardiac thrombus formation in 6 patients (20%) and clot was visualized grossly in the pump head in 2 patients (6%) necessitating pump-head change. Nine patients (30%) were discharged home. We conclude that the use of heparin-coated extracorporeal life support without systemic heparinization, especially after protamine has been used to reverse systemic heparinization in patients having postcardiotomy cardiogenic shock, may be dangerous. Extracorporeal life support has introduced new complications unique to itself specifically limb ischemia, oxygenator failure, and pump-head thrombus. (J THORAC CARDIOVASC SURG 1995;110: 843-51) |
| Databáze: | OpenAIRE |
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