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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
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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.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

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

For information regarding this article, E-mail: gabriel.parzy@ap-hm.fr

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