Post-cardiotomy venovenous extracorporeal membrane oxygenation without heparinization

• Published in: General thoracic and cardiovascular surgery Vol. 67; no. 11; pp. 982 - 986
• Main Authors: Takagaki, Masami, Yamaguchi, Hiroki, Ikeda, Naoko, Takeda, Kaori, Kasai, Fumihito, Yahagi, Kiyotaka, Kanzaki, Shunji, Mitsuyama, Shinichi, Kadowaki, Tasuku, Kotani, Toru
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.11.2019; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Anticoagulants - therapeutic use; Cardiac arrhythmia; Cardiac Surgery; Cardiac Surgical Procedures - adverse effects; Cardiology; Cardiovascular disease; Case Report; Contraindications; Contraindications, Drug; Engineers; Extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - methods; Heart surgery; Hemodialysis; Hemoptysis; Hemorrhage - etiology; Heparin - therapeutic use; Hospitals; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Patients; Physiology; Surgical apparatus & instruments; Surgical Oncology; Survival Rate; Thoracic Surgery; Weaning; Post-cardiotomy; Extracorporeal membrane oxygenation; Anticoagulation; Heparinization
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-018-0990-2

We present the cases of eight patients (mean age 75 years; EuroSCORE II 17.0 ± 22.0) who underwent post-cardiotomy venovenous extracorporeal membrane oxygenation (ECMO) without heparinization due to serious bleeding. Three liver cirrhosis, two chronic hemodialysis, three redo sternotomy, and two urgent surgery cases were included. Respiratory ECMO Survival Prediction score was − 5.1 ± 4.2 (estimated survival rate: approximately 30%). Mean ECMO duration was 14 days with 9 circuit exchanges. Five patients were weaned from ECMO and three were discharged alive at 90 days (survival 37.5%). There was a case of pump-head thrombosis requiring urgent circuit exchange. All experienced bleeding complications without clinically apparent pulmonary thromboembolism. Disseminated Intravascular Coagulation scores (Pre 1.3 ± 0.8 vs. Post 3.8 ± 1.7; p  < 0.05) significantly increased ( N  = 6). Post-cardiotomy ECMO without heparinization facilitated patient rescue at a reasonable survival rate. However, bleeding complications were still observed. More sophisticated management protocols are warranted.