In a review of 12 adult cardiothoracic patients who developed intracardiac thrombosis while on venoarterial extracorporeal membrane oxygenation, mortality was high, with only 2 patients surviving.
What are the clinical characteristics and outcomes of intracardiac thrombosis complicating VA ECMO in adult cardiothoracic patients?
Intracardiac thrombosis during VA ECMO is a highly fatal complication that frequently occurs despite perceived adequate systemic anticoagulation, highlighting the need for vigilant monitoring.
Venoarterial extracorporeal membrane oxygenation (VA ECMO) has become an indispensable treatment option for adult cardiothoracic patients experiencing acute refractory cardiogenic shock. VA ECMO is not without inherent complications as in-hospital mortality has ranged from 45% to 65% (1-3). Intracardiac thrombosis (ICT) is a rare but life-threatening complication associated with VA ECMO. VA ECMO cases complicated by ICT were searched for using the MEDLINE (PubMed and OVID), Society of Cardiovascular Anesthesiology Headquarters, and Google Scholar databases. Twelve cases of VA ECMO-associated ICT were discovered for review. Indications for VA ECMO were postcardiotomy cardiogenic shock and heart failure. The primary location of thrombus was the left ventricle and aortic root. Majority of the cases did not report subtherapeutic systemic anticoagulation. Two patients survived after the development of ICT. VA ECMO-associated ICT is a devastating consequence with high mortality. The majority of ICT occurred in cases with perceived adequate anticoagulation, but this may not result in complete suppression of the coagulation response. Continued exposure to procoagulant stimuli and worsening ventricular function and intracardiac stasis can shift the balance toward a hypercoagulable state and development of thrombosis.
Williams et al. (Thu,) conducted a review in Venoarterial extracorporeal membrane oxygenation (VA ECMO)-associated intracardiac thrombosis (n=12). Venoarterial extracorporeal membrane oxygenation (VA ECMO) was evaluated on Survival after development of intracardiac thrombosis. In a review of 12 adult cardiothoracic patients who developed intracardiac thrombosis while on venoarterial extracorporeal membrane oxygenation, mortality was high, with only 2 patients surviving.