Refractory Respiratory Failure
Conditions
Brief summary
Unfractionated heparin (UFH) is worldwide anticoagulation used and recommended anticoagulation in patients with ECMO support. However, it is accompanied with incidence of bleeding or thrombotic compliaction at about 40-60% and high mortality. Because ECMO produce primary haemosthasis pathology, there is a theory that prophylaxis of thrombosis with low molecular weight heparin (LMWH) e.g. Enoxaparin might be sufficient to prevent ECMO throbosis and thrombosis development in patients. We decided to performed retrospective observation study and analysis of data, from may 2019 until august 2023, in all patients who were put on VV ECMO and to analysis incidence of bleeding, thrombotic and neurologic complications.
Detailed description
Unfractionated heparin (UFH) is worldwide anticoagulation used and recommended anticoagulation in patients with ECMO support. However, it is accompanied with incidence of bleeding or thrombotic compliaction at about 40-60% and high mortality. Because ECMO produce primary haemosthasis pathology, there is a theory that prophylaxis of thrombosis with low molecular weight heparin (LMWH) e.g. Enoxaparin might be sufficient to prevent ECMO throbosis and thrombosis development in patients. This phenomenon of primary haemosthasis pathology may protect ECMO from thrombotic complication as primary haemosthasis plays major role in haemosthasis taking places in high shear stress condiditon such as ECMO. Because LMWH is connected with lower incidence of bleeding complication and HIT (heparin induced thrombocytopenia) in general, in case that patients on VV ECMO developed primary haemosthasis pathology detected by PFA 200, we started to use LMWH instead of UFH in VV ECMO patients. We decided to performed retrospective observation study and analysis of data, from may 2019 until august 2023, in all patients who were put on VV ECMO and to analysis incidence of bleeding, thrombotic and neurologic complications. We want to compare this incidence of compliactions with data known from patients with other studies using UFH.
Interventions
OTHERNo intervention, just retrospective analysis of data.
Sponsors
University Hospital, Motol
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* VV ECMO - use of 2 separate cannulas (jugular and femoral) * anticoagulation with only intravenous continuous LMWH (Enoxaparin) * only a period of the first ECMO set running
Exclusion criteria
* pregnancy * Avalon cannula (one double lumen cannula) * patients after thoraco-abdominal surgery * patients after lung transplantation in early postoperative period * patients after trauma without any type of heparin ,,heparin free ECMO
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of major bleeding complications | Daty from may 2019 till august 2023 | Defined by ECMO registry |
| Incidence of major thrombotic complications | Daty from may 2019 till august 2023 | Defined by ECMO registry |
| Incidence of major neurologic complications | Daty from may 2019 till august 2023 | Defined by ECMO registry |
Countries
Czechia
Outcome results
None listed