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Incidence and Risk Factors for Cannula-Related Venous Thrombosis After Venovenous Extracorporeal Membrane Oxygenation in Adult Patients With Acute Respiratory Failure

Fisser, Christoph, MD1; Reichenbächer, Christoph, MD1; Müller, Thomas, MD1; Schneckenpointner, Roland, MD1; Malfertheiner, Maximilian V., MD1; Philipp, Alois2; Foltan, Maik2; Lunz, Dirk, MD3; Zeman, Florian, MSc4; Lubnow, Matthias, MD1

doi: 10.1097/CCM.0000000000003650
Online Clinical Investigations
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Objectives: Venovenous extracorporeal membrane oxygenation is indicated in patients with severe refractory acute respiratory failure. Venous thrombosis due to indwelling catheters is a frequent complication. The aim of this study was to analyze the incidence of cannula-related thrombosis and its risk factors after venovenous extracorporeal membrane oxygenation.

Design: Retrospective observational study.

Setting: A medical ICU at the University Hospital Regensburg.

Patients: We analyzed consecutive patients with severe respiratory failure (PaO2/FIO2 < 85 mm Hg and/or respiratory acidosis with pH < 7.25) who were successfully treated with venovenous extracorporeal membrane oxygenation in a medical ICU between 2010 and 2017.

Intervention: None.

Measurements and Main Results: After extracorporeal membrane oxygenation weaning, duplex sonography or CT was conducted to detect cannula-related thrombosis. Thrombosis was classified as a large thrombosis by vein occlusion of greater than 50%. The incidence of thrombosis was correlated with risk factors such as coagulation variables (mean activated partial thromboplastin time ≤ 50 s, international normalized ratio antithrombin III, fibrinogen, plasma-free hemoglobin, platelets, and decline in D-dimer ≤ 50% the day after decannulation), cannula size, time on venovenous extracorporeal membrane oxygenation, renal failure, and underlying malignant disease. Data cut-off points were identified by receiver operating characteristic analysis. One-hundred seventy-two of 197 patients (87%) were screened. One-hundred six patients (62%) showed thrombosis that was considered large in 48 of 172 (28%). The incidence of thrombosis was higher in patients with a mean aPTT of less than or equal to 50 seconds (odds ratio, 1.02; p = 0.013) and in patients with a decline in D-dimer less than or equal to 50% (odds ratio, 2.76; p = 0.041) the day after decannulation following adjustment for risk factors.

Conclusions: The incidence of cannula-related venous thrombosis after venovenous extracorporeal membrane oxygenation is high. Reduced systemic anticoagulation may enhance the risk of thrombosis. Sustained elevation of D-dimer after decannulation may indicate thrombosis. Patients should undergo routine duplex sonography after extracorporeal membrane oxygenation to detect thrombosis formation in the cannulated vessel.

1Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.

2Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany.

3Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany.

4Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany.

Drs. Fisser and Reichenbächer were responsible for drafting the article and were involved in the acquisition of data, analysis and interpretation of this information, and the critical revision of the article prior to submission. Drs. Müller and Lubnow were responsible for the conception, hypotheses delineation, and the design of the study, as well as for the acquisition of data, analysis and interpretation of this information, writing the article, and its revision prior to submission. Drs. Schneckenpointner, Malfertheiner, Philipp, Foltan, Lunz, and Zeman were involved in the acquisition of data, analysis and interpretation of this information, and the critical revision of the article prior to submission.

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. Zeman’s institution received funding from Chugai and European Organisation for Research and Treatment of Cancer. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, Email: christoph.fisser@ukr.de

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