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Use of a fixed, body weight-unadjusted loading dose of unfractionated heparin for extracorporeal cardiopulmonary resuscitation.

Iwashita Y, Yukimitsu M, Matsuduki M, Yamamoto A, Ishikura K, Imai H - J Intensive Care (2015)

Bottom Line: The mean heparin dose per kilogram body weight, mean initial ACT, and mean duration of cardiopulmonary resuscitation (CPR) did not statistically differ between the patients who experienced fatal bleeding and those who did not.Fixed-dose heparin of 3000-U bolus resulted in a mean heparin dose per kilogram body weight of 53.6 U/kg and an ACT of 231.3 s and experienced 3 out of 32 fatal bleedings.Further researches are warranted to optimize anticoagulation protocol for ECPR patients.

View Article: PubMed Central - PubMed

Affiliation: Emergency and Critical Care Center, Mie University Hospital, Edobashi 2-174, Tsu, Mie Japan.

ABSTRACT

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is being used increasingly in the emergency and critical care field in Japan. A major complication of ECPR is bleeding; however, the optimal initial heparin dose and activated coagulation time (ACT) remain unknown. The aim of this study was to assess the appropriateness of our initial anticoagulation protocol.

Methods: We retrospectively evaluated the initial heparin dose, ACT value, and incidence of bleeding and thrombotic complications in post-cardiopulmonary arrest patients who received a fixed, body weight-unadjusted loading dose of unfractionated heparin (3000 U) prior to veno-arterial extracorporeal membrane oxygenator (ECMO) between February 2011 and November 2013 at Mie University Hospital, Japan.

Results: ACT was evaluated within 3 h of initiation of 32 consecutive ECPR patients. The mean heparin dose per body weight was 53.6 U/kg and the mean ACT was 231.3 s. In 17 patients, ACT exceeded 200 s. Three patients experienced fatal bleeding in the chest wall within 24 h of receiving ECMO. The mean heparin dose per kilogram body weight, mean initial ACT, and mean duration of cardiopulmonary resuscitation (CPR) did not statistically differ between the patients who experienced fatal bleeding and those who did not.

Conclusions: Fixed-dose heparin of 3000-U bolus resulted in a mean heparin dose per kilogram body weight of 53.6 U/kg and an ACT of 231.3 s and experienced 3 out of 32 fatal bleedings. Further researches are warranted to optimize anticoagulation protocol for ECPR patients.

No MeSH data available.


Related in: MedlinePlus

Study overview. Extracorporeal membrane oxygenation (ECMO) was initiated in 45 consecutive patients. Thirteen patients were excluded from the study because activated coagulation time (ACT) was not determined within 3 h of admission to the intensive care unit. The remaining 24 patients were included in the present study
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Fig1: Study overview. Extracorporeal membrane oxygenation (ECMO) was initiated in 45 consecutive patients. Thirteen patients were excluded from the study because activated coagulation time (ACT) was not determined within 3 h of admission to the intensive care unit. The remaining 24 patients were included in the present study

Mentions: ECMO was initiated in 45 patients during the study period (Fig. 1). In one patient, ECMO was initiated twice during the same hospitalization. In all other patients, ECMO was initiated once at each hospitalization. ACT was not measured within 3 h of admission to the intensive care unit in 13 patients so they were excluded from the study. Table 2 shows the patient demographics. The mean age was 60.4 years. Twenty-seven patients (84.3 %) were male. Nine patients (37.5 %) experienced cardiac arrest during hospitalization. The mean duration of conventional CPR prior to the initiation of ECMO was 48.6 min. The mean initial heparin dose was 53.6 U/kg body weight, and the mean initial ACT was 231.3 s.Fig 1


Use of a fixed, body weight-unadjusted loading dose of unfractionated heparin for extracorporeal cardiopulmonary resuscitation.

Iwashita Y, Yukimitsu M, Matsuduki M, Yamamoto A, Ishikura K, Imai H - J Intensive Care (2015)

Study overview. Extracorporeal membrane oxygenation (ECMO) was initiated in 45 consecutive patients. Thirteen patients were excluded from the study because activated coagulation time (ACT) was not determined within 3 h of admission to the intensive care unit. The remaining 24 patients were included in the present study
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4508880&req=5

Fig1: Study overview. Extracorporeal membrane oxygenation (ECMO) was initiated in 45 consecutive patients. Thirteen patients were excluded from the study because activated coagulation time (ACT) was not determined within 3 h of admission to the intensive care unit. The remaining 24 patients were included in the present study
Mentions: ECMO was initiated in 45 patients during the study period (Fig. 1). In one patient, ECMO was initiated twice during the same hospitalization. In all other patients, ECMO was initiated once at each hospitalization. ACT was not measured within 3 h of admission to the intensive care unit in 13 patients so they were excluded from the study. Table 2 shows the patient demographics. The mean age was 60.4 years. Twenty-seven patients (84.3 %) were male. Nine patients (37.5 %) experienced cardiac arrest during hospitalization. The mean duration of conventional CPR prior to the initiation of ECMO was 48.6 min. The mean initial heparin dose was 53.6 U/kg body weight, and the mean initial ACT was 231.3 s.Fig 1

Bottom Line: The mean heparin dose per kilogram body weight, mean initial ACT, and mean duration of cardiopulmonary resuscitation (CPR) did not statistically differ between the patients who experienced fatal bleeding and those who did not.Fixed-dose heparin of 3000-U bolus resulted in a mean heparin dose per kilogram body weight of 53.6 U/kg and an ACT of 231.3 s and experienced 3 out of 32 fatal bleedings.Further researches are warranted to optimize anticoagulation protocol for ECPR patients.

View Article: PubMed Central - PubMed

Affiliation: Emergency and Critical Care Center, Mie University Hospital, Edobashi 2-174, Tsu, Mie Japan.

ABSTRACT

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is being used increasingly in the emergency and critical care field in Japan. A major complication of ECPR is bleeding; however, the optimal initial heparin dose and activated coagulation time (ACT) remain unknown. The aim of this study was to assess the appropriateness of our initial anticoagulation protocol.

Methods: We retrospectively evaluated the initial heparin dose, ACT value, and incidence of bleeding and thrombotic complications in post-cardiopulmonary arrest patients who received a fixed, body weight-unadjusted loading dose of unfractionated heparin (3000 U) prior to veno-arterial extracorporeal membrane oxygenator (ECMO) between February 2011 and November 2013 at Mie University Hospital, Japan.

Results: ACT was evaluated within 3 h of initiation of 32 consecutive ECPR patients. The mean heparin dose per body weight was 53.6 U/kg and the mean ACT was 231.3 s. In 17 patients, ACT exceeded 200 s. Three patients experienced fatal bleeding in the chest wall within 24 h of receiving ECMO. The mean heparin dose per kilogram body weight, mean initial ACT, and mean duration of cardiopulmonary resuscitation (CPR) did not statistically differ between the patients who experienced fatal bleeding and those who did not.

Conclusions: Fixed-dose heparin of 3000-U bolus resulted in a mean heparin dose per kilogram body weight of 53.6 U/kg and an ACT of 231.3 s and experienced 3 out of 32 fatal bleedings. Further researches are warranted to optimize anticoagulation protocol for ECPR patients.

No MeSH data available.


Related in: MedlinePlus