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Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO C. Amarelli Department of Cardiovascular Surgery.

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Presentation on theme: "Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO C. Amarelli Department of Cardiovascular Surgery."— Presentation transcript:

1 Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO C. Amarelli Department of Cardiovascular Surgery and Transplants Ospedale Monaldi - Azienda Ospedaliera dei Colli – Naples -Italy

2 Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Background: ECMO is an effective strategy to mantain an optimal peripheral perfusion in patients affected from acute heart failure.

3 Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Background: Coagulative disorders, Ventilator Associated Pneumonia (VAP) and infectious complications are frequent in patient treated with ECMO and may affect prognosis in such patients. Blood derivatives usage may be the link between coagulative disorders, VAP and blood-stream infections (BSI) associated with ECMO.

4 Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Background: Use of bivaluridin has been advocated to avoid heparin induced thrombocytopenia, its complications and the consumption of blood derivatives, but there are not enough data to support this policy.

5 Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Methods: In a tertiary care center for Heart Transplantation (HT) and Cardiovascular Surgery during the last three years 22 pts were implanted with Levitronix ECMO (20 central and 2 peripheral cannulation) and concurrently treated either with bivaluridin (10 pts, aiming to reduce coagulative disorders) or with heparin (12 pts, when short support periods were expected). Study Aim: To Assess the impact of this two different strategies of anticoagulation on the outcomes in a small monocentric pilot experience.

6 Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Methods All patients were extubated immediately after implantation whenever neurologically feasible.Weaning was performed according to the Aissaoui's criteria at minimal ECMO flow. All weaned patients had aortic VTI10 cm,LVEF 20-25%, and TDSa C6 cm/s at minimal flows The indication for ECMO were 9 Primary Graft Failures, 4 post-cardiotomy, 5 acute complications of myocardial infarction and single cases of Acute Myocarditis, Acute Rejection and ACS.

7 Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Results ECMO was always successful to warrant optimal perfusion. Three patient underwent successful HT. Three patient underwent Interventricular Septum Closure. Mortality on ECMO was 5/20 (25%). Hospital mortality was 8/20 (40%). In the Heparin Group one ECMO (postcardiotomy) was futile due to Cerebral Anoxia (brain death on first postimplant day) and one for an early surgical massive bleeding. Only 10 patients for group were considered in the outcomes analysis.

8 Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Results Heparin (10 pts, 3 Ped) Bivaliruridin (10 pts, Adults) Bleeding Requiring surgical reopening 3/100/10 RBC Units23.3± ±5.9 FP Units6.1±8.10.7±1.5 Platelets17.5± ±3 Mortality on ECMO3/102/10 Hospital Mortality4/10 Weaning4/10 (3 successful)4/10 (2 successful) Transplant0/103/10

9 Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO BivaluridinHeparin

10 Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Single Center Experience On Different Anticoagulation Protocols In The Management Of Veno-Arterial ECMO Conclusions A novel approach in the management of ECMO based on bivaluridin reduce bleedings and coagulative complications, although hospital mortality remain still high due to the poor preoperative conditions.


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