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D ‐dimers Are a Predictor of Clot Volume Inside Membrane Oxygenators During Extracorporeal Membrane Oxygenation
Author(s) -
Dornia Christian,
Philipp Alois,
Bauer Stefan,
Stroszczynski Christian,
Schreyer Andreas G.,
Müller Thomas,
Koehl Gudrun E.,
Lehle Karla
Publication year - 2015
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12460
Subject(s) - extracorporeal membrane oxygenation , membrane oxygenator , coagulation , platelet , d dimer , oxygenator , thrombosis , medicine , fibrinogen , anesthesia , cardiology , chemistry , cardiopulmonary bypass
Thrombosis inside the membrane oxygenator ( MO ) is a critical complication during venovenous extracorporeal membrane oxygenation ( ECMO ). The aim of this study was to prove if thrombotic clots manifest within the MO when D ‐dimer levels are elevated over a long‐term period. Heparin‐coated polymethylpentene MOs ( n  = 13) were exchanged due to high plasma D ‐dimer levels. Clot volume was calculated using multidetector computed tomography ( MDCT ). Coagulation parameters and MO function were analyzed before and after MO exchange. Before MO exchange, D ‐dimer levels increased significantly in each patient (11.5 [6.5–15.5] mg/L to 35.0 [34–35] mg/L, P  ≤ 0.001). High levels of D ‐dimers were tolerated for 1 to 6 days. Additionally, fibrinogen concentration ( n  = 8) and platelet count decreased ( n  = 8). Within 48 h after exchange, D ‐dimer levels decreased significantly ( n  = 11, 12 [8–16] mg/L, P  = 0.004). Fibrinogen concentration and platelet counts increased. Clots were found in all MOs in the inlet part of the device. Clot volume (16–106 cm 3 ) did not correlate with MO support time but increased significantly when high D ‐dimer levels were accepted for >2 days. An increase or high levels of D ‐dimers in absence of other explaining pathology during ECMO therapy reflected coagulation activity within the MO . Evidence of clots within the MO at high D ‐dimer levels and decrease after exchange underline the relevance of D ‐dimer testing during ECMO treatment. Besides, surveillance of MOs during ongoing ECMO therapy will help to predict clot formation, and to avoid system‐induced coagulation disorders as well as critical situations.

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