ECMO review - no anticoagulation, better outcome (VA ECMO)

Venoarterial ECMO Without Routine Systemic Anticoagulation Decreases Adverse Events

Katherine L. Wood, MD, Brian Ayers, MBA, Igor Gosev, MD, Neil Kumar, MD,
Amber L. Melvin, MD, Bryan Barrus, MD, and Sunil Prasad, MD

(Ann Thorac Surg 2020;-:---)

2020 by The Society of Thoracic Surgeons

 

Background

In 2010, Lamarche and colleagues19 reported their experience without systemic anticoagulation in 32 adult patients supported on VA-ECMO for postcardiotomy shock or extracorporeal-assisted cardiopulmonary resuscitation. Their results showed no increase in thromboembolic events, and the patients required fewer packed red blood cell transfusions;

 

Results

Overall complication rates were significantly lower for the no anticoagulation group (57% versus 76%; P[.007) including a trend toward fewer hemorrhagic complications (53% versus 63%; P [ .178) without increased risk of thrombosis (13% versus 21%; P [ .147).

No significant difference was found in overall in-hospital mortality between the cohorts (AC: 62%; No-AC: 72%;
P ¼ .165).

 

Further study points

The no-AC group had a lower incidence of hemorrhagic complications that required intervention, as well as a
paradoxically lower incidence of thrombotic complications. Neither was statistically significant.

The study could not report on the aPTT or ACT values for the no-AC cohort because these tests were not routinely
assessed.

A prospective randomized trial is needed to substantiate our findings.