Trudzinski Franziska C, Minko Peter, Rapp Daniel, Fähndrich Sebastian, Haake Hendrik, Haab Myriam, Bohle Rainer M, Flaig Monika, Kaestner Franziska, Bals Robert, Wilkens Heinrike, Muellenbach Ralf M, Link Andreas, Groesdonk Heinrich V, Lensch Christian, Langer Frank, Lepper Philipp M
Department of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital of Saarland, Homburg, Germany.
Ann Intensive Care. 2016 Dec;6(1):66. doi: 10.1186/s13613-016-0172-2. Epub 2016 Jul 19.
Even though bleeding and thromboembolic events are major complications of extracorporeal membrane oxygenation (ECMO), data on the incidence of venous thrombosis (VT) and thromboembolism (VTE) under ECMO are scarce. This study analyzes the incidence and predictors of VTE in patients treated with ECMO due to respiratory failure.
Retrospective analysis of patients treated on ECMO in our center from 04/2010 to 11/2015. Patients with thromboembolic events prior to admission were excluded. Diagnosis was made by imaging in survivors and postmortem examination in deceased patients.
Out of 102 screened cases, 42 survivors and 21 autopsy cases [mean age 46.0 ± 14.4 years; 37 (58.7 %) males] fulfilling the above-mentioned criteria were included. Thirty-four patients (54.0 %) underwent ECMO therapy due to ARDS, and 29 patients (46.0 %) with chronic organ failure were bridged to lung transplantation. Despite systemic anticoagulation at a mean PTT of 50.6 ± 12.8 s, [VT/VTE 47.0 ± 12.3 s and no VT/VTE 53.63 ± 12.51 s (p = 0.037)], VT and/or VTE was observed in 29 cases (46.1 %). The rate of V. cava thrombosis was 15/29 (51.7 %). Diagnosis of pulmonary embolism prevailed in deceased patients [5/21 (23.8 %) vs. 2/42 (4.8 %) (p = 0.036)]. In a multivariable analysis, only aPTT and time on ECMO predicted VT/VTE. There was no difference in the incidence of clinically diagnosed VT in ECMO survivors and autopsy findings.
Venous thrombosis and thromboembolism following ECMO therapy are frequent. Quality of anticoagulation and ECMO runtime predicted thromboembolic events.
尽管出血和血栓栓塞事件是体外膜肺氧合（ECMO）的主要并发症，但关于ECMO下静脉血栓形成（VT）和血栓栓塞（VTE）发生率的数据却很稀少。本研究分析了因呼吸衰竭接受ECMO治疗的患者中VTE的发生率及预测因素。
对2010年4月至2015年11月在本中心接受ECMO治疗的患者进行回顾性分析。排除入院前有血栓栓塞事件的患者。通过影像学检查对存活患者进行诊断，对死亡患者进行尸检诊断。
在102例筛查病例中，纳入了42例存活患者和21例尸检病例[平均年龄46.0±14.4岁；37例（58.7%）为男性]，符合上述标准。34例患者（54.0%）因急性呼吸窘迫综合征（ARDS）接受ECMO治疗，29例慢性器官衰竭患者接受ECMO治疗以过渡到肺移植。尽管全身抗凝使活化部分凝血活酶时间（PTT）平均为50.6±12.8秒，[发生VT/VTE者PTT为47.0±12.3秒，未发生VT/VTE者PTT为53.63±12.51秒（p=0.037）]，但仍有29例（46.1%）观察到VT和/或VTE。腔静脉血栓形成率为15/29（51.7%）。肺栓塞在死亡患者中的诊断更为常见[5/21（23.8%）对2/42（4.8%）（p=0.036）]。在多变量分析中，只有活化部分凝血活酶时间（aPTT）和ECMO治疗时间可预测VT/VTE。ECMO存活患者临床诊断VT的发生率与尸检结果无差异。
ECMO治疗后静脉血栓形成和血栓栓塞很常见。抗凝质量和ECMO运行时间可预测血栓栓塞事件。
