Coagulation factor deficiencies during initiation of extracorporeal membrane oxygenation.
OBJECTIVE
We examined the hypothesis that critically ill patients receiving extracorporeal membrane oxygenation (ECMO) have reduced clotting factor levels, which may contribute to the risk of hemorrhagic complications.


METHODS
Blood samples were collected from 19 patients before and 1 hour after initiation of ECMO. Heparin present in samples was removed by ECTEOLA (epichlorohydrin triethanolamine) cellulose resin adsorption, and coagulation factors were assayed by automated techniques. Factor deficiency was defined as levels at least 2 SD less than published age-adjusted reference values.


RESULTS
Thirteen patients (68%) had deficiencies of two or more factors before ECMO. Despite inclusion of factor-containing blood products in the ECMO priming solution, 10 patients (53%) had deficiencies of two or more factors after initiation of ECMO. Four patients had intracranial hemorrhages and were found to be deficient in five or more factors at the time of cannulation.


CONCLUSIONS
Severe coagulation factor deficiencies are often present in patients requiring ECMO, and coagulation factors provided through the circuit prime are insufficient to ensure correction of these deficiencies. Deficiency of multiple coagulation factors may contribute to the risk of intracranial hemorrhage during ECMO; the practice of excluding factor-containing solutions from the circuit prime should be examined prospectively.
McManus
M L
ML
Multidisciplinary Intensive Care Unit, Children's Hospital, Boston, MA 02115, USA.
Kevy
S V
SV
Bower
L K
LK
Hickey
P R
PR
D001778:Blood Coagulation Disorders / Q000150:complications*; D001779:Blood Coagulation Factors / Q000032:analysis; D001927:Brain Diseases / Q000209:etiology; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn
D001779:Blood Coagulation Factors