Key result
In patients receiving ECMO, an increase in D-dimer (mean difference 22.6 µg/mL) or a decrease in fibrinogen, platelet count, or heparin dose over 3 days significantly predicted an impending need for membrane oxygenator exchange.
Why the study?
Thrombosis within the membrane oxygenator during ECMO can cause sudden oxygenator dysfunction, creating a need to identify predictors of circuit exchange.
Do changes in D-dimer, fibrinogen, platelet count, and heparin dose predict the need for membrane oxygenator exchange in patients receiving ECMO?
Observational (n=150)
No
Do changes in D-dimer, fibrinogen, platelet count, and heparin dose predict the need for membrane oxygenator exchange in patients receiving ECMO?
Mean Difference: 22.6 (95% CI 21.1–24.2)
p-value: p=0.001
Increasing D-dimer and decreasing fibrinogen, platelet count, and heparin requirements can serve as early predictors of impending membrane oxygenator dysfunction in patients receiving ECMO.
Thrombosis within the membrane oxygenator (MO) during extracorporeal membrane oxygenation (ECMO) can lead to sudden oxygenator dysfunction with deleterious effects to the patient. The purpose of this study was to identify predictors of circuit exchange during ECMO. This is a single-center, retrospective study of all patients who received ECMO at our institution from January 2010 to December 2015. Changes in potential markers were compared on Day 3 vs. Day 0 before MO exchange. Of the 150 patients who received ECMO, there were 58 MO exchanges in 35 patients. Mean ECMO duration was 21.1 (±12.7) days. D-dimer (DD) (μg/mL) (mean difference −2.6; 95% confidence interval [CI]: −4.2 to −1.1; p = .001) increased significantly in the 3 days leading up to MO exchange, whereas fibrinogen (mg/dL) (mean difference 90.7; 95% CI: 41.8–139.6; p = .001), platelet (PLT) count (1,000/μL) (mean difference 23.3; 95% CI: 10.2–36.4; p = .001), and heparin dose (units/h) (mean difference 261.7; 95% CI: 46.3–477.1; p = .02) decreased. Increasing DD or decreasing fibrinogen, PLT count, or heparin dose may indicate an impending need for MO exchange in patients receiving ECMO. Early identification of these changes may help prevent sudden MO dysfunction.
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Basken et al. (2019) conducted an observational in Patients receiving Extracorporeal Membrane Oxygenation (ECMO) (n=150). Changes in laboratory parameters (D-dimer, fibrinogen, platelet count, heparin dose) vs. Day 3 vs Day 0 before membrane oxygenator exchange was evaluated on Change in D-dimer (µg/mL) from Day 3 to Day 0 before membrane oxygenator exchange (MD 22.6, 95% CI 21.1-24.2, p=0.001). In patients receiving ECMO, an increase in D-dimer (mean difference 22.6 µg/mL) or a decrease in fibrinogen, platelet count, or heparin dose over 3 days significantly predicted an impending need for membrane oxygenator exchange.
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