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Prevalence and Risk Factors for Thrombotic Complications Following Venovenous Extracorporeal Membrane Oxygenation

A CT Scan Study

Parzy, Gabriel MD1,2; Daviet, Florence MD1,2; Persico, Nicolas MD1–3; Rambaud, Romain MD1; Scemama, Ugo MD4; Adda, Mélanie MD1,2; Guervilly, Christophe MD1,2; Hraiech, Sami MD, PhD1,2; Chaumoitre, Kathia MD, PhD4; Roch, Antoine MD, PhD1–3; Papazian, Laurent MD, PhD1,2; Forel, Jean-Marie MD1,2

doi: 10.1097/CCM.0000000000004129
Clinical Investigation: PDF Only

Objectives: The aims of this study were to: 1) analyze the cannula-associated deep vein thrombosis frequency after venovenous extracorporeal membrane oxygenation using a CT scan and 2) identify the associated risk factors for cannula-associated deep vein thrombosis.

Design: Retrospective observational analysis at a single center.

Setting: Tertiary referral university teaching hospital.

Patients: Patients under venovenous extracorporeal membrane oxygenation with a femorofemoral or femorojugular cannulation admitted for acute respiratory distress syndrome or primary graft dysfunction after pulmonary transplantation. CT scan was performed within 4 days after decannulation.

Interventions: None.

Measurements and Main Results: We included 105 of 228 patients screened. Bacterial pneumonia was the main indication of venovenous extracorporeal membrane oxygenation (46.7%). CT scans were performed at a median of 2 days (1–3 d) after decannulation. Cannula-associated deep vein thrombosis was found in 75 patients (71.4%) despite it having a mean activated partial thromboplastin time ratio of 1.60 ± 0.31. Femorofemoral cannulation induced femoral cannula-associated deep vein thrombosis more frequently than femorojugular cannulation (69.2% vs 63.1%, respectively; p = 0.04). Seventeen of the 105 patients (16.2%) had a pulmonary embolism. Multivariate logistic regression analysis showed that higher the percentage of thrombocytopenia less than 100 G/L during extracorporeal membrane oxygenation period, lower the risk for developing cannula-associated deep vein thrombosis (hazard ratio, 0.98; 95% CI, 0.98–1.00; p = 0.02).

Conclusions: Cannula-associated deep vein thrombosis after venovenous extracorporeal membrane oxygenation is a frequent complication. This plead for a systematic vascular axis imaging after venovenous extracorporeal membrane oxygenation. Thrombocytopenia is associated with a reduction in the occurrence of thrombotic events.

1Médecine Intensive Réanimation Détresses Respiratoires et Infection Sévères, AP-HM, CHU Nord, Marseille, France.

2CEReSS - Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France.

3Service d’Accueil des Urgences, AP-HM, CHU Nord, Marseille, France.

4Service d’Imagerie Médicale, AP-HM, CHU Nord, Marseille, France.

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Dr. Guervilly received funding from Xenios/Fresenius Medical Care. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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