title: D-dimers as an early marker for oxygenator exchange in extracorporeal membrane oxygenation.
abstract: OBJECTIVE
  Early markers of oxygenator dysfunction during prolonged use of extracorporeal membrane oxygenation (ECMO) are important for timely exchange to avoid sudden loss of function due to clot formation within the system. The measurement of D-dimers (DDs) in plasma might be a marker for early diagnosis of thrombus formation and dysfunction of heparin-coated membrane oxygenators (MOs).
  
  
  METHODS
  This is a retrospective study on prospectively collected data of 24 adult acute respiratory distress syndrome patients requiring long-term veno-venous ECMO with at least 1 MO exchange. Kinetics of coagulation, inflammation, and oxygenator function were analyzed before and after MO exchange.
  
  
  RESULTS
  Median (interquartile range) support duration is 20 (15-29) days. Thirty-four MOs had to be replaced. Exchange occurred due to visible thrombus formation in the MO (n=16), worsening gas exchange (n=11), increased blood flow resistance (n=1), and activation of coagulation with diffuse bleeding (n=6). In 15 cases, DDs were continuously elevated and, therefore, not suitable as marker for MO exchange. In the remaining 19 cases, DDs increased significantly within 3 days before exchange from 15 (9-20) to 30 (21-35) mg/dL (P=.002) and declined significantly within 1 day thereafter to 13 (7-17) mg/dL (P=.003).
  
  
  CONCLUSIONS
  An increase in plasma DD concentration in absence of other explaining pathology can be helpful in predicting an MO exchange in miniaturized heparin-coated ECMO systems.
authors: Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany. Electronic address: matthias.lubnow@ukr.de.
authors: Matthias
authors: M
authors: Lubnow
authors: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
authors: Alois
authors: A
authors: Philipp
authors: Department of Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
authors: Christian
authors: C
authors: Dornia
authors: Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
authors: Stephan
authors: S
authors: Schroll
authors: Department of Anesthesiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
authors: Thomas
authors: T
authors: Bein
authors: Department of Anesthesiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
authors: Marcus
authors: M
authors: Creutzenberg
authors: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
authors: Claudius
authors: C
authors: Diez
authors: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
authors: Christof
authors: C
authors: Schmid
authors: Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
authors: Michael
authors: M
authors: Pfeifer
authors: Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
authors: Günther
authors: G
authors: Riegger
authors: Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
authors: Thomas
authors: T
authors: Müller
authors: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
authors: Karla
authors: K
authors: Lehle
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D004868:Equipment Failure; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006493:Heparin; D006801:Humans; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D010106:Oxygenators; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000628:therapy; D012189:Retrospective Studies; D013927:Thrombosis
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D006493:Heparin
keywords: ECMO; Extracorporeal membrane oxygenation; Oxygenator dysfunction; Oxygenator exchange; Thrombosis; d-dimers