Extracorporeal lung assist with heparin-coated systems.
Extracorporeal lung assist (ELA) has been recommended for the treatment of ARDS if conventional therapy fails. However, the need for nearly complete anticoagulation is a major risk factor for hemorrhagic complications. We describe our experience with 13 ARDS patients treated with ELA using heparin-coated systems (Carmeda). Maintaining partial thromboplastin time and activated clotting time within or close to the normal range, even major surgery (20 thoracotomies and 2 laparotomies) could be performed without undue bleeding complications related to anticoagulation during extracorporeal support. Eight of the 13 patients survived. The use of heparin-coated systems allows prolonged ELA with nearly physiological coagulation function, permitting major surgical intervention. It enhances the safety margin of extracorporeal gas exchange and may ultimately extend its indications.
Rossaint
R
R
Department of Anesthesiology, Free University of Berlin, Germany.
Slama
K
K
Lewandowski
K
K
Streich
R
R
Henin
P
P
Hopfe
T
T
Barth
H
H
Nienhaus
M
M
Weidemann
H
H
Lemmens
P
P
D000328:Adult; D001672:Biocompatible Materials; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D005260:Female; D006493:Heparin; D006801:Humans; D008297:Male; D010107:Oxygenators, Membrane; D011175:Positive-Pressure Respiration; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*
D001672:Biocompatible Materials; D006493:Heparin