Buscher Hergen, Vukomanovic Alexander, Benzimra Mark, Okada Kazuhiro, Nair Priya
Department of Intensive Care, St. Vincent's Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia.
Department of Intensive Care, St. Vincent's Hospital, Sydney, Australia.
J Cardiothorac Vasc Anesth. 2017 Jun;31(3):869-875. doi: 10.1053/j.jvca.2016.10.015. Epub 2016 Oct 17.
To describe blood management and anticoagulation practice for cardiac and respiratory extracorporeal membrane oxygenation (ECMO) with consideration of major surgery at the time of its initiation.
A single-center retrospective review over 18 months of blood product usage and anticoagulation in patients treated with veno-venous (VV) ECMO versus veno-arterial (VA) ECMO and after major surgery (Sx) versus no surgery (Nsx).
Tertiary metropolitan hospital and state ECMO referral and heart and lung transplantation center.
The study comprised 42 patients representing 48 consecutive ECMO runs (16 VV, 32 VA, 26 Sx, 22 Nsx).
None.
Thirty-three percent of the total run time of 362 days was with no continuous infusion of heparin. The mean (standard deviation) daily dose of heparin was lower for Sx versus Nsx patients (11,397 [9,297] v 17,324 [10,387] U, p = 0.047). Sx patients also received more fresh frozen plasma (1.1 [1.93] v 0.2 [0.59] U per day, p = 0.049) and platelets (0.5 [0.51] v 0.1 [0.25] U per day, p = 0.003). VV patients received fewer packed red cells (0.7 [0.45] v 2.0 [2.04] U per day, p = 0.016) and platelets (0.1 [0.18] v 0.4 [0.49] U per day, p = 0.008) compared with VA patients. Survival to hospital discharge was 69%.
Heparin doses were low, with frequent interruption of anticoagulation. This was more pronounced in patients with a high bleeding risk recovering from major surgery. The overall usage of blood products was low in VV and Nsx patients, with an overall excellent survival rate.
描述心脏和呼吸体外膜肺氧合（ECMO）的血液管理和抗凝实践，并考虑启动ECMO时的大手术情况。
对18个月内接受静脉-静脉（VV）ECMO与静脉-动脉（VA）ECMO治疗以及大手术（Sx）与未手术（Nsx）患者的血液制品使用和抗凝情况进行单中心回顾性研究。
三级城市医院及州ECMO转诊和心肺移植中心。
该研究包括42例患者，代表48次连续的ECMO运行（16次VV，32次VA，26次Sx，22次Nsx）。
无。
在362天的总运行时间中，33%的时间未持续输注肝素。Sx患者的肝素平均（标准差）日剂量低于Nsx患者（11,397 [9,297] 与17,324 [10,387] U，p = 0.047）。Sx患者还接受了更多的新鲜冰冻血浆（每天1.1 [1.93] 与0.2 [0.59] U，p = 0.049）和血小板（每天0.5 [0.51] 与0.1 [0.25] U，p = 0.003）。与VA患者相比，VV患者接受的浓缩红细胞（每天0.7 [0.45] 与2.0 [2.04] U，p = 0.016）和血小板（每天0.1 [0.18] 与0.4 [0.49] U，p = 0.008）更少。出院生存率为69%。
肝素剂量较低，抗凝经常中断。这在大手术后出血风险高的患者中更为明显。VV和Nsx患者的血液制品总体使用量较低，总体生存率良好。
