title: Extracorporeal membrane oxygenation bridging to lung transplant complicated by heparin-induced thrombocytopenia.
abstract: In patients with acute respiratory failure and life-threatening impairment of pulmonary gas exchange, venovenous extracorporeal membrane oxygenation offers further therapeutic options. During extracorporeal membrane oxygenation treatment, systemic anticoagulation is usually achieved by heparin administration, which exposes patients to the risk of heparin-induced thrombocytopenia type II. We present a patient with acute respiratory distress syndrome on venovenous extracorporeal membrane oxygenation who experienced heparin-induced thrombocytopenia type II and in whom anticoagulation was continued with argatroban. Because respiratory failure did not resolve, the patient was bridged to lung transplant with extracorporeal membrane oxygenation. Argatroban anticoagulation was safely used until lung transplant (on day 114 after extracorporeal membrane oxygenation initiation) and after transplant in the presence of hepatic failure.
authors.affiliation: Department of Anesthesiology, University Hospital Grosshadern, Ludwig-Maximilians-University, 81377 Munich, Germany. Michael.Dolch@med.uni-muenchen.de
authors.forename: Michael E
authors.initials: ME
authors.lastname: Dolch
authors.forename: Lorenz
authors.initials: L
authors.lastname: Frey
authors.forename: Rudolf
authors.initials: R
authors.lastname: Hatz
authors.forename: Peter A
authors.initials: PA
authors.lastname: Uberfuhr
authors.forename: Andres
authors.initials: A
authors.lastname: Beiras-Fernandez
authors.forename: Jurgen
authors.initials: J
authors.lastname: Behr
authors.forename: Michael
authors.initials: M
authors.lastname: Irlbeck
authors.forename: The Munich
authors.initials: TM
authors.lastname: Lung Transplant Group
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D001120:Arginine / Q000031:analogs & derivatives; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D017809:Fatal Outcome; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D010875:Pipecolic Acids / Q000627:therapeutic use; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000097:blood / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban