Acquired coagulation disorders during extracorporeal carbon dioxide removal

Abstract

Introduction: Bleeding and transfusion requirements are frequent complications under veno-venous extracorporeal carbon dioxide removal (ECCO₂R). Data concerning coagulation in ECCO₂R patients are few. We therefore aimed to analyze hemostatic changes during extracorporeal carbon dioxide removal.

Methods: Single center analysis. 20 Patients undergoing pump-driven ECCO₂R between 03/13 and 10/15 were included. According our protocol, platelet count and fibrinogen testing were performed on a daily base; factor XIII analysis was done before ECCO₂R and twice a week.

Results: Results: 19 Patients, 11 male, mean age 50.2 ± 13.2 were finally analyzed. ECCO₂R was initiated due to AECOPD in 12 cases (60%), to chronic respiratory failure in patients waiting for lung transplantation in 7 cases (35%), to ARDS in 2 Cases (%) and to refractory status asthmaticus in one case (5%). Mean ECCO₂R runtime was 9.6 ± 7.6 days. Within the first 7 days platelet count decreased from 265.2 ± 78.2 (N=17) to 131 ± 48.18 (N=15) platelets/µl (P = 0.003). HIT-II Elisa was performed in 11 cases (57.9%) and was positive in one of them (9.1%). Fibrinogen decreased from 483.1 ± 142.8 (N=18) at baseline to 364.8 ± 95.8 mg/dl (N=15) on day 7 (P =0.002). Factor XIII measurement showed an acquired deficiency under support dropping from 84.5 ± 14.8 (N=14) before ECCO2R to 69.9 ± 11.7 % on day 2-5 (N= 8) (P=0.018). Four Patients received purified concentrate of blood coagulation factor XIII.

Conclusion: Patients on ECCO2R develop coagulation disorders analog High-flow ECMO patients. The impact on bleeding complications and thromboembolic events needs further investigation.