Prevalence Of “Flat-Line” Thromboelastography During Extracorporeal Membrane Oxygenation For Respiratory Failure In Adults

Mauro Panigada, Giacomo Iapichino, Camilla L’Acqua, Alessandro Protti, Massimo Cressoni, Dario Consonni, Cristina Mietto, Luciano Gattinoni

Research output: Contribution to journalArticlepeer-review

Abstract

We evaluated the prevalence of a thromboelastography reaction time (R time) > 90 minutes (“flat-line”) reversible with heparinase during Extracorporeal Membrane Oxygenation (ECMO). We evaluated the association between “flat-line” thromboelastography, other coagulation tests and risk of bleeding during ECMO. 32 consecutive patients on ECMO were included. Anticoagulation was provided by continuous infusion of unfractionated heparin to maintain an activated partial thromboplastin time (aPTT) ratio between 1.5-2.0. Activated clotting time (ACT), thromboelastography without and with heparinase were measured. Occurrence of bleeding was recorded. Median heparin infusion rate was 16 (12-20) IU/Kg/h, aPTT ratio was 1.67 (1.48-1.96) and ACT was 173 (161-184) sec. 145 (46%) of 316 paired thromboelastography samples were “flat-lines” all reversed with heparinase. Patients with “flat-line” thromboelastography received more heparin (p=0.001) but had similar platelet count (p=0.164) and fibrinogen level (p=0.952) than those without. APTT, ACT and R time without heparinase weakly correlated between each other (Spearman correlation ≤0.36) with poor agreement (Cohen’s kappa ≤0.10). Major bleeding occurred in 7 (22%) patients. Bleeding during ECMO was not predicted by any of the used test. In conclusion adjusting heparin infusion to maintain aPTT ratio between 1.5-2.0 frequently resulted in “flat-line” thromboelastography.

Original languageEnglish
Pages (from-to)302-309
Number of pages8
JournalASAIO Journal
Volume62
Issue number3
DOIs
Publication statusPublished - 2016

ASJC Scopus subject areas

  • Biophysics
  • Biomaterials
  • Bioengineering
  • Biomedical Engineering
  • Medicine(all)

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