Journal Article

Thrombolysis for ECMO oxygenator thrombosis

Taccone, Fabio Silvio, Annoni, Filippo, Nobile, Leda

2023

Overview

Informed consent was waived by our Ethics Committee because the data collection was retrospective from the data patient monitoring system (PDMS). SEE PDF] The first patient was on V-V ECMO during the first COVID-19 wave and was fully dependent on the ECMO support because of severe respiratory failure; after 4 days on ECMO, the oxygenator showed rapid signs of clotting (i.e., ECMO flow reduced to 3 L/min) and arterial oxygenation dropped to 55%. Because of no chance of survival considering the time required to have a perfusionist available, the administration of low-dose rtPA (5 mg bolus followed by additional 5 mg after 5 min) into the drainage section of the oxygenator was decided; within 15 min, the ECMO flow returned to the initial baseline values. The reason we decided to continue with UFH was due to the relatively low anti-Xa values at clotting, which suggest a potentially insufficient anticoagulation regimen rather than the ineffectiveness of UFH. [...]the indication for oxygenator exchange in case of suspected thrombosis is also undetermined and might be based on membrane performance, hemolysis and/or patient’s status [4].

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Anticoagulants / Blood clot / Blood oxygenation, Extracorporeal / Care and treatment / Coronaviruses / Correspondence / COVID-19 / Critical care / Critical Care Medicine / Diagnosis / Dosage and administration / Drug dosages / Emergency Medicine / Extracorporeal Membrane Oxygenation / Fibrinolysis / Humans / Intensive / Medicine / Medicine & Public Health / Oxygenators / Patient outcomes / Patients / Surgical apparatus & instruments / Thrombolytic drugs / Thrombolytic Therapy / Thrombosis / Thrombosis - drug therapy