Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial...

Single Center Experience On Different Anticoagulation

Protocols In The Management Of Veno-Arterial ECMOC. Amarelli

Department of Cardiovascular Surgery and TransplantsOspedale Monaldi - Azienda Ospedaliera dei Colli – Naples -Italy

Single Center Experience On Different AnticoagulationProtocols In The Management Of Veno-Arterial ECMO

Background:ECMO is an effective strategy to mantain an optimal peripheral perfusion in patients affected from acute heart failure.


Background:

Coagulative disorders, Ventilator Associated Pneumonia (VAP) and infectious complications are frequent in patient treated with ECMO and may affect prognosis in such patients.

Blood derivatives usage may be the link between coagulative disorders, VAP and blood-stream infections (BSI) associated with ECMO.


Background: Use of bivaluridin has been advocated to avoid heparin induced thrombocytopenia, its complications and the consumption of blood derivatives, but there are not enough data to support this policy.

B-L

?

ECTissue factor

PF-4

Heparin

Heparansulfat

Thrombin

PLT

FC RIIa


Methods:In a tertiary care center for Heart Transplantation (HT) and Cardiovascular Surgery during the last three years 22 pts were implanted with Levitronix ECMO (20 central and 2 peripheral cannulation) and concurrently treated either with bivaluridin (10 pts, aiming to reduce coagulative disorders) or with heparin (12 pts, when short support periods were expected) .

Study Aim:

To Assess the impact of this two different strategies of anticoagulation on the outcomes in a small monocentric pilot experience.


MethodsAll patients were extubated immediately after implantation whenever neurologically feasible.Weaning was performed according to the Aissaoui's criteria at minimal ECMO flow.

All weaned patients had aortic VTI≥10 cm,LVEF≥ 20-25%, and TDSa ≥ C6 cm/s at minimal flows

The indication for ECMO were 9 Primary Graft Failures, 4 post-cardiotomy, 5 acute complications of myocardial infarction and single cases of Acute Myocarditis, Acute Rejection and ACS.


Results

ECMO was always successful to warrant optimal perfusion.

Three patient underwent successful HT.

Three patient underwent Interventricular Septum Closure.

Mortality on ECMO was 5/20 (25%).

Hospital mortality was 8/20 (40%).

In the Heparin Group one ECMO (postcardiotomy) was futile due to Cerebral Anoxia (brain death on first postimplant day) and one for an early surgical massive bleeding.

Only 10 patients for group were considered in the outcome’s analysis.


Results

Heparin (10 pts, 3 Ped)

Bivaliruridin (10 pts, Adults)

Bleeding Requiring surgical reopening

3/10 0/10

RBC Units 23.3±22.1 9.8±5.9

FP Units 6.1±8.1 0.7±1.5

Platelets 17.5±22.2 1.1±3

Mortality on ECMO 3/10 2/10

Hospital Mortality 4/10 4/10

Weaning 4/10 (3 successful) 4/10 (2 successful)

Transplant 0/10 3/10


30-O

ct

30-O

ct

31-O

ct

31-O

ct

01-N

ov

01-N

ov

02-N

ov

02-N

ov

03-N

ov

03-N

ov

04-N

ov

04-N

ov

05-N

ov

05-N

ov

06-N

ov

06-N

ov

07-N

ov0

50

100

150

200

250

0

50

100

150

200

250

300

350

400

450

ACT

PTT

INR

Fib

AT3

PLT

Bivaluridin Heparin


Conclusions

A novel approach in the management of ECMO based on bivaluridin reduce bleedings and coagulative complications, although hospital mortality remain still high due to the poor preoperative conditions.

Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial...

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