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Acquired coagulation disorders during extracorporeal carbon dioxide removal

Franziska Trudzinski, Frederik Seiler, Sebastian Fähndrich, Franziska Kaestner, Monika Flaig, Tom Wolf, Ralf M. Muellenbach, Robert Bals, Christian Lensch, Philipp M. Lepper
European Respiratory Journal 2016 48: PA3574; DOI: 10.1183/13993003.congress-2016.PA3574
Franziska Trudzinski
1Dept. of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany
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Frederik Seiler
1Dept. of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany
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Sebastian Fähndrich
1Dept. of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany
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Franziska Kaestner
1Dept. of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany
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Monika Flaig
1Dept. of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany
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Tom Wolf
2Dept. of Thoracic and Cardiovascular Surgery, University Hospital of Saarland, Homburg, Germany
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Ralf M. Muellenbach
3Dept. of Anaesthesiology, University Hospital of Würzburg, Würzburg, Germany
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Robert Bals
1Dept. of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany
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Christian Lensch
1Dept. of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany
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Philipp M. Lepper
1Dept. of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany
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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.

  • Intensive care
  • ARDS (Acute Respiratory Distress Syndrome)
  • COPD - management
  • Copyright ©the authors 2016
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Acquired coagulation disorders during extracorporeal carbon dioxide removal
Franziska Trudzinski, Frederik Seiler, Sebastian Fähndrich, Franziska Kaestner, Monika Flaig, Tom Wolf, Ralf M. Muellenbach, Robert Bals, Christian Lensch, Philipp M. Lepper
European Respiratory Journal Sep 2016, 48 (suppl 60) PA3574; DOI: 10.1183/13993003.congress-2016.PA3574

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Acquired coagulation disorders during extracorporeal carbon dioxide removal
Franziska Trudzinski, Frederik Seiler, Sebastian Fähndrich, Franziska Kaestner, Monika Flaig, Tom Wolf, Ralf M. Muellenbach, Robert Bals, Christian Lensch, Philipp M. Lepper
European Respiratory Journal Sep 2016, 48 (suppl 60) PA3574; DOI: 10.1183/13993003.congress-2016.PA3574
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