Dornia Christian, Philipp Alois, Bauer Stefan, Stroszczynski Christian, Schreyer Andreas G, Müller Thomas, Koehl Gudrun E, Lehle Karla
Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
Artif Organs. 2015 Sep;39(9):782-7. doi: 10.1111/aor.12460. Epub 2015 Apr 7.
Thrombosis inside the membrane oxygenator (MO) is a critical complication during venovenous extracorporeal membrane oxygenation (ECMO). The aim of this study was to prove if thrombotic clots manifest within the MO when D-dimer levels are elevated over a long-term period. Heparin-coated polymethylpentene MOs (n = 13) were exchanged due to high plasma D-dimer levels. Clot volume was calculated using multidetector computed tomography (MDCT). Coagulation parameters and MO function were analyzed before and after MO exchange. Before MO exchange, D-dimer levels increased significantly in each patient (11.5 [6.5-15.5] mg/L to 35.0 [34-35] mg/L, P ≤ 0.001). High levels of D-dimers were tolerated for 1 to 6 days. Additionally, fibrinogen concentration (n = 8) and platelet count decreased (n = 8). Within 48 h after exchange, D-dimer levels decreased significantly (n = 11, 12 [8-16] mg/L, P = 0.004). Fibrinogen concentration and platelet counts increased. Clots were found in all MOs in the inlet part of the device. Clot volume (16-106 cm(3) ) did not correlate with MO support time but increased significantly when high D-dimer levels were accepted for >2 days. An increase or high levels of D-dimers in absence of other explaining pathology during ECMO therapy reflected coagulation activity within the MO. Evidence of clots within the MO at high D-dimer levels and decrease after exchange underline the relevance of D-dimer testing during ECMO treatment. Besides, surveillance of MOs during ongoing ECMO therapy will help to predict clot formation, and to avoid system-induced coagulation disorders as well as critical situations.
膜式氧合器（MO）内血栓形成是静脉-静脉体外膜肺氧合（ECMO）期间的一种严重并发症。本研究的目的是证实当D-二聚体水平长期升高时，MO内是否会出现血栓。由于血浆D-二聚体水平升高，更换了肝素涂层聚甲基戊烯MO（n = 13）。使用多排螺旋计算机断层扫描（MDCT）计算凝块体积。在MO更换前后分析凝血参数和MO功能。在MO更换前，每位患者的D-二聚体水平显著升高（从11.5[6.5 - 15.5]mg/L升至35.0[34 - 35]mg/L，P≤0.001）。高水平的D-二聚体持续1至6天。此外，纤维蛋白原浓度（n = 8）和血小板计数下降（n = 8）。更换后48小时内，D-二聚体水平显著下降（n = 11，从12[8 - 16]mg/L降至，P = 0.004）。纤维蛋白原浓度和血小板计数增加。在所有MO的装置入口部分均发现有凝块。凝块体积（16 - 106 cm³）与MO支持时间无关，但当高水平D-二聚体持续>2天时显著增加。在ECMO治疗期间，在没有其他解释性病理情况下D-二聚体升高或处于高水平反映了MO内的凝血活性。高水平D-二聚体时MO内有凝块的证据以及更换后凝块减少强调了ECMO治疗期间D-二聚体检测的相关性。此外，在持续的ECMO治疗期间监测MO将有助于预测凝块形成，并避免系统诱导的凝血障碍以及危急情况。
