Lubnow Matthias, Philipp Alois, Dornia Christian, Schroll Stephan, Bein Thomas, Creutzenberg Marcus, Diez Claudius, Schmid Christof, Pfeifer Michael, Riegger Günther, Müller Thomas, Lehle Karla
Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
J Crit Care. 2014 Jun;29(3):473.e1-5. doi: 10.1016/j.jcrc.2013.12.008. Epub 2013 Dec 30.
Early markers of oxygenator dysfunction during prolonged use of extracorporeal membrane oxygenation (ECMO) are important for timely exchange to avoid sudden loss of function due to clot formation within the system. The measurement of D-dimers (DDs) in plasma might be a marker for early diagnosis of thrombus formation and dysfunction of heparin-coated membrane oxygenators (MOs).
This is a retrospective study on prospectively collected data of 24 adult acute respiratory distress syndrome patients requiring long-term veno-venous ECMO with at least 1 MO exchange. Kinetics of coagulation, inflammation, and oxygenator function were analyzed before and after MO exchange.
Median (interquartile range) support duration is 20 (15-29) days. Thirty-four MOs had to be replaced. Exchange occurred due to visible thrombus formation in the MO (n=16), worsening gas exchange (n=11), increased blood flow resistance (n=1), and activation of coagulation with diffuse bleeding (n=6). In 15 cases, DDs were continuously elevated and, therefore, not suitable as marker for MO exchange. In the remaining 19 cases, DDs increased significantly within 3 days before exchange from 15 (9-20) to 30 (21-35) mg/dL (P=.002) and declined significantly within 1 day thereafter to 13 (7-17) mg/dL (P=.003).
An increase in plasma DD concentration in absence of other explaining pathology can be helpful in predicting an MO exchange in miniaturized heparin-coated ECMO systems.
在体外膜肺氧合（ECMO）长期使用过程中，氧合器功能障碍的早期标志物对于及时更换至关重要，可避免因系统内血栓形成导致功能突然丧失。血浆D - 二聚体（DDs）的测量可能是肝素涂层膜肺氧合器（MOs）血栓形成和功能障碍早期诊断的标志物。
这是一项回顾性研究，对24例需要长期静脉 - 静脉ECMO且至少进行1次MO更换的成年急性呼吸窘迫综合征患者的前瞻性收集数据进行分析。分析了MO更换前后的凝血、炎症和氧合器功能动力学。
中位（四分位间距）支持时间为20（15 - 29）天。共需更换34个MOs。更换原因包括MO中可见血栓形成（n = 16）、气体交换恶化（n = 11）、血流阻力增加（n = 1）以及凝血激活伴弥漫性出血（n = 6）。在15例患者中，DDs持续升高，因此不适合作为MO更换的标志物。在其余19例患者中，DDs在更换前3天内显著升高，从15（9 - 20）mg/dL增至30（21 - 35）mg/dL（P = .002），并在更换后1天内显著降至13（7 - 17）mg/dL（P = .003）。
在没有其他可解释病理情况时，血浆DD浓度升高有助于预测小型肝素涂层ECMO系统中的MO更换。
