title: Comparison between clinical indicators of transmembrane oxygenator thrombosis and multidetector computed tomographic analysis.
abstract: This study aims to assess whether multidetector computed tomography (MDCT) could accurately confirm the clinical suspicion of transmembrane oxygenator thrombosis (MOT) during extracorporeal membrane oxygenation (ECMO). Twenty-seven oxygenators were examined using MDCT at the end of patient treatment. Transmembrane oxygenator thrombosis was suspected in 15 of them according to the presence of at least 2 of the following clinical indicators: (1) increase in d-dimer, (2) decrease in platelet count, (3) decrease in oxygenator performance, and (4) presence of clots on the surface of the oxygenator. Transmembrane oxygenator thrombosis was confirmed by MDCT in 5 (33%) of them. Transmembrane oxygenator thrombosis was unexpectedly found in 5 (41%) of the remaining 12 oxygenators not suspected for MOT. Eight (80%) of these oxygenators had clots accounting for less than 1% of total volume. Clots were mainly detectable at the apical corner of the oxygenator, most likely due to greater blood stasis. We found a significant increase in d-dimer and in membrane oxygenator shunt and a decrease in platelet count from the start to the discontinuation of ECMO. Hemostatic abnormalities significantly reverted 48 hours after oxygenator removal, suggesting the role of ECMO in activation of the coagulation cascade. Multidetector computed tomographic scan could not accurately confirm the clinical suspicion of MOT.
authors.affiliation: Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: panigadm@gmail.com.
authors.forename: Mauro
authors.initials: M
authors.lastname: Panigada
authors.affiliation: Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: L'Acqua
authors.affiliation: Centro Emofilia e Trombosi, A. Bianchi Bonomi, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Serena Maria
authors.initials: SM
authors.lastname: Passamonti
authors.affiliation: Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Mietto
authors.affiliation: Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Protti
authors.affiliation: Dipartimento dei Servizi, Radiologia Pronto Soccorso, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Riva
authors.affiliation: Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Gattinoni
mesh_terms: D001777:Blood Coagulation; D004868:Equipment Failure; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D005338:Fibrin Fibrinogen Degradation Products; D006801:Humans; D061330:Multidetector Computed Tomography; D010107:Oxygenators, Membrane; D010976:Platelet Count; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000628:therapy*; D013927:Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Computed tomography; ECMO; Oxygenator; Oxygenator exchange; Thrombosis; Transmembrane oxygenator thrombosis