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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

Computed tomography scans showing intra-thoracic, thoracic, and mediastinal bleeding, presumably caused by excessive chest compression, in the three patients in the present study who experienced fatal bleeding
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Fig2: Computed tomography scans showing intra-thoracic, thoracic, and mediastinal bleeding, presumably caused by excessive chest compression, in the three patients in the present study who experienced fatal bleeding

Mentions: Nine out of the thirty-two patients (28.1 %) survived to discharge, six of whom had a good neurological outcome (Cerebral Performance Category 1 or 2). The causes of death in the patients that died included cerebral hypoxia, low cardiac output syndrome, and multiple organ failure. Three patients experienced fatal bleeding during ECMO (Table 3), two of whom died as a consequence. The remaining patient underwent interventional radiology to stop the haemorrhage but died due to low cardiac output syndrome. Figure 2 shows computed tomography scans of the three patients who experienced fatal bleeding; thoracic, intra-thoracic, and mediastinal bleeding can be seen. There were no significant differences in age (P = 0.33), sex (P = 0.84), mean initial heparin dose (P = 0.42), mean initial ACT (P = 0.89), or mean duration of conventional CPR (P = 0.18) between the patients who experienced fatal bleeding and those who did not (Table 3). No significant thrombotic complications were observed.Table 3


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)

Computed tomography scans showing intra-thoracic, thoracic, and mediastinal bleeding, presumably caused by excessive chest compression, in the three patients in the present study who experienced fatal bleeding
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Computed tomography scans showing intra-thoracic, thoracic, and mediastinal bleeding, presumably caused by excessive chest compression, in the three patients in the present study who experienced fatal bleeding
Mentions: Nine out of the thirty-two patients (28.1 %) survived to discharge, six of whom had a good neurological outcome (Cerebral Performance Category 1 or 2). The causes of death in the patients that died included cerebral hypoxia, low cardiac output syndrome, and multiple organ failure. Three patients experienced fatal bleeding during ECMO (Table 3), two of whom died as a consequence. The remaining patient underwent interventional radiology to stop the haemorrhage but died due to low cardiac output syndrome. Figure 2 shows computed tomography scans of the three patients who experienced fatal bleeding; thoracic, intra-thoracic, and mediastinal bleeding can be seen. There were no significant differences in age (P = 0.33), sex (P = 0.84), mean initial heparin dose (P = 0.42), mean initial ACT (P = 0.89), or mean duration of conventional CPR (P = 0.18) between the patients who experienced fatal bleeding and those who did not (Table 3). No significant thrombotic complications were observed.Table 3

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