Zhen Guo1, Lin Sun1, Bailing Li2, Rui Tian3, Xiaolin Zhang4, Zhongwei Zhang5, Sean P Clifford6, Yuan Liu7, Jiapeng Huang8, Xin Li9. 1. Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China. 2. Department of Cardiovascular Surgery, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai, China. 3. Department of Emergency and Critical Care, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China. 4. Department of Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China. 5. Department of Intensive Care Unit, Fudan University Shanghai Cancer Center, Shanghai, China. 6. Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY. 7. Department of Statistics Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China. 8. Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY. Electronic address: jiapeng.huang@louisville.edu. 9. Department of Cardiovascular Surgery. Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: li.xin3@zs-hospital.sh.cn.
Abstract
OBJECTIVE: To explore special coagulation characteristics and anticoagulation management in extracorporeal membrane oxygenation (ECMO)-assisted patients with coronavirus disease 2019 (COVID-19). DESIGN: Single-center, retrospective observation of a series of patients. PARTICIPANTS: Laboratory-confirmed severe COVID-19 patients who received venovenous ECMO support from January 20-May 20, 2020. INTERVENTIONS: This study analyzed the anticoagulation management and monitoring strategies, bleeding complications, and thrombotic events during ECMO support. MEASUREMENTS AND MAIN RESULTS: Eight of 667 confirmed COVID-19 patients received venovenous ECMO and had an elevated D-dimer level before and during ECMO support. An ECMO circuit pack (oxygenator and tubing) was replaced a total of 13 times in all 8 patients, and coagulation-related complications included oxygenator thrombosis (7/8), tracheal hemorrhage (5/8), oronasal hemorrhage (3/8), thoracic hemorrhage (3/8), bleeding at puncture sites (4/8), and cannulation site hemorrhage (2/8). CONCLUSIONS: Hypercoagulability and secondary hyperfibrinolysis during ECMO support in COVID-19 patients are common and possibly increase the propensity for thrombotic events and failure of the oxygenator. Currently, there is not enough evidence to support a more aggressive anticoagulation strategy.
OBJECTIVE: To explore special coagulation characteristics and anticoagulation management in extracorporeal membrane oxygenation (ECMO)-assisted patients with coronavirus disease 2019 (COVID-19). DESIGN: Single-center, retrospective observation of a series of patients. PARTICIPANTS: Laboratory-confirmed severe COVID-19patients who received venovenous ECMO support from January 20-May 20, 2020. INTERVENTIONS: This study analyzed the anticoagulation management and monitoring strategies, bleeding complications, and thrombotic events during ECMO support. MEASUREMENTS AND MAIN RESULTS: Eight of 667 confirmed COVID-19patients received venovenous ECMO and had an elevated D-dimer level before and during ECMO support. An ECMO circuit pack (oxygenator and tubing) was replaced a total of 13 times in all 8 patients, and coagulation-related complications included oxygenator thrombosis (7/8), tracheal hemorrhage (5/8), oronasal hemorrhage (3/8), thoracic hemorrhage (3/8), bleeding at puncture sites (4/8), and cannulation site hemorrhage (2/8). CONCLUSIONS:Hypercoagulability and secondary hyperfibrinolysis during ECMO support in COVID-19patients are common and possibly increase the propensity for thrombotic events and failure of the oxygenator. Currently, there is not enough evidence to support a more aggressive anticoagulation strategy.
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