Protocolized Bedside Decannulation On Therapeutic Anticoagulation In Veno-venous Extracorporeal Membrane Oxygenation (VV Ecmo) Patients Reduces The Risk Of Cannula-associated Deep Vein Thrombosis (CaDVT) Without Increasing Hemorrhagic Complications
Robin B. Osofsky, MD, Ronald Orozco, BA, Jaideep Das Gupta, MD, Ross Clark, MD, LeAnn A. Chavez, MD, Mark Langsfeld, MD, John Marek, MD, Muhammad A. Rana, MD, Jonathan S. Marinaro, MD, Sundeep S. Guliani, MD.
University of New Mexico, Albuquerque, NM, USA.
OBJECTIVE: The incidence of cannula-associated deep vein thrombosis (CaDVT) in patients following veno-venous extracorporeal membrane oxygenation (VV ECMO) is prominent with literature incidence as high as 85.4%. Our objective was to evaluate the impact of protocolized bedside decannulation on therapeutic anticoagulation in regards to CaDVT and hemorrhagic complications.
METHODS: Single-centered retrospective review of clinical data with emphasis on CaDVT incidence of all consecutive patients admitted from 2016-2019 requiring VV ECMO and subsequent adherence to CaDVT prevention protocol, which includes bedside purse-string decannulation while on therapeutic systemic anticoagulation with routine duplex CaDVT screening at 48hr and 14 days. Patients without evidence of CaDVT at 48 hours are then transitioned to prophylactic anticoagulation dosing. Patients who expired prior to decannulation and or had ongoing hemorrhagic complications prior to decannulation were excluded from protocol.
RESULTS: 18 total patients received VV ECMO over the study period. 11 patients (9 male, 2 female, mean age 41.42±14.82 years) met criteria for the CaDVT prevention protocol. Mean ECMO duration was 349.20±14.82 hours and mean PTT at 48 hr post decannulation was 61.13±18.15. Four (18.18%) of 22 femoral cannula sites developed CaDVTs. Of the of 3 (27.27%) patients that developed CaDVTs, anatomic distribution was: right common femoral vein (n=1), left common femoral vein (n=1), and bilateral common femoral veins (n=1). All patients with CaDVTs were subsequently treated with full systemic anticoagulation for 3 months. In the CaDVT protocol group, zero patients developed cannula site hematomas and zero patients had transfusion requirements within the first 48 hours of decannulation. Two (18.18%) patients required vasopressor support within 48 hours of decannulation secondary to ongoing sepsis. No patient required a subsequent procedure for groin hemorrhage control. In patients with and without the development of CaDVT, there were no significant differences in age (38.55±18.41 vs. 36.60±17.76 years, P=0.7325), BMI (27.37±6.18 vs. 39.74±10.31, P=0.0944), ECMO duration (319.69±176.53 vs. 319.12±275.95 hours, P=0.9974), or cannula size (26.50±1.91 vs. 26.63±2.45 French, P=0.9257).
CONCLUSIONS: Implementation of CaDVT prevention protocol at our institution demonstrated decreased incidence of CaDVT following VV ECMO compared to literature data with no significant bleeding complications. With promising early results, the merit of this protocol should be explored further as sample size was limited.
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