| Complications of extracorporeal life support systems using heparin-bound surfaces. The risk of intracardiac clot formation. | |
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MedLine Citation:
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PMID: 7564454 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Extracorporeal life support with heparin-coated extracorporeal membrane oxygenation circuits are being used with increased frequency in patients who have cardiogenic shock. We report our experience in 30 patients with cardiogenic shock, looking specifically at the complications associated with this form of life support. Thirty patients with a mean age of 46.5 +/- 16.6 years received extracorporeal life support for a mean of 62.8 +/- 41.1 hours (range 0.5 to 159 hours). Twenty-three patients had postcardiotomy cardiogenic shock, five had acute myocardial infarction, and one each had acute cardiac deterioration after a balloon coronary angioplasty and another after pulmonary artery balloon angioplasty. Peripheral (femoral vein to femoral artery) cannulation was used in 24 patients. Limb ischemia developed in 21 patients (70%), renal failure in 17 patients (57%), oxygenator failure requiring change in 13 patients (43%), bleeding requiring reexploration in 12 (40%), and infection in 9 patients (30%). Transesophageal echocardiography revealed intracardiac thrombus formation in 6 patients (20%) and clot was visualized grossly in the pump head in 2 patients (6%) necessitating pump-head change. Nine patients (30%) were discharged home. We conclude that the use of heparin-coated extracorporeal life support without systemic heparinization, especially after protamine has been used to reverse systemic heparinization in patients having postcardiotomy cardiogenic shock, may be dangerous. Extracorporeal life support has introduced new complications unique to itself specifically limb ischemia, oxygenator failure, and pump-head thrombus. |
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Authors:
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D D Muehrcke; P M McCarthy; R W Stewart; S Seshagiri; D A Ogella; R C Foster; D M Cosgrove |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 110 ISSN: 0022-5223 ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 1995 Sep |
Date Detail:
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Created Date: 1995-10-23 Completed Date: 1995-10-23 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 843-51 Citation Subset: AIM; IM |
Affiliation:
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Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Child Child, Preschool Echocardiography, Transesophageal Extracorporeal Membrane Oxygenation / adverse effects*, methods, mortality Extremities / blood supply Female Heart Diseases / etiology*, ultrasonography Heparin / adverse effects* Humans Ischemia / etiology Life Support Care* Logistic Models Male Middle Aged Multivariate Analysis Shock, Cardiogenic / mortality, therapy Survival Rate Thrombosis / etiology*, ultrasonography |
| Chemical | |
Reg. No./Substance:
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9005-49-6/Heparin |
| Comments/Corrections | |
Comment In:
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J Thorac Cardiovasc Surg. 1996 Jul;112(1):206-7
[PMID:
8691878
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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