title: Extracorporeal membrane oxygenation with heparin-coated systems in a 13-month-old infant with acute hypoxic respiratory failure after correction of tetralogy of Fallot.
abstract: Hemorrhagic disorders due to systemic heparinization are frequent during extracorporeal lung support (veno-venous extracorporeal membrane oxygenation: vv-ECMO). The development of heparin-coated systems has reduced the need for high-dose heparinization. Whereas the use of these heparin-coated membrane lungs and tubings has been described in former studies in adults, only few reports exist in children. This case report describes the application of a heparin-coated extracorporeal system for long-term vv-ECMO in a 13-month-old infant suffering from acute hypoxic respiratory failure after correction of tetralogy of Fallot. Only moderately elevated levels of activated clotting time (ACT, 120-160 s) and activated partial thromboplastin time (aPTT, 40-60 s) were necessary to avoid thrombotic events in the extracorporeal system. Thoracotomies were performed twice without bleeding complications by discontinuation of the systemic heparinization. We conclude that the use of heparin-coated membrane lungs in infants may improve the safety of extracorporeal lung support and permits surgical intervention without major risk of bleeding.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Rudolf Virchow Clinic, Free University of Berlin, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Keh
authors.forename: R
authors.initials: R
authors.lastname: Rossaint
authors.forename: R
authors.initials: R
authors.lastname: Streich
authors.forename: H
authors.initials: H
authors.lastname: Gerlach
authors.forename: D
authors.initials: D
authors.lastname: Pappert
authors.forename: H
authors.initials: H
authors.lastname: Kramer
authors.forename: K J
authors.initials: KJ
authors.lastname: Falke
mesh_terms: D000208:Acute Disease; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D006470:Hemorrhage / Q000517:prevention & control; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D000860:Hypoxia / Q000628:therapy*; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000628:therapy*; D013771:Tetralogy of Fallot / Q000601:surgery*
chemical_list: D006493:Heparin