Fayaz Mohammed Khazi , Ashraf Mahmoud Elhoufi , Tarek Ahmed AbdelAziz , Nayyer R Siddiqui , Bassil Al-Zamkan , Suresh Babu Robert , Pradeep Kumar Pillai , Obaid Aljassim
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引用次数: 2
Abstract
Objective
The management of Heparin resistance in patients undergoing ECMO is still uncertain. We sought to assess the efficacy and safety of Fresh frozen plasma to optimize the anticoagulation in these patients.
Methods
We studied 42 adults undergoing VA-ECMO. Heparin infusion was increased incrementally to achieve target ACT in HG group and plasma administered in FFPG group in heparin resistance (HR) patients. Statistical comparison was performed between these two groups and results compared with non-heparin resistance (Non-HR) patients.
Results
Overall 36% survived and 64% suffered bleeding complications. There was no difference in age (p = 0.118) or average ECMO duration (p = 0.393). The heparin requirement was significantly less in FFPG (p = 0.008) and average ACT difference of 159.2 (20.3) was highly significant (p < 0.001). Clinically the survival was higher in FFPG (50% vs 10%) without statistical difference (p = 0.07) probably due to small sample size. Twenty HR compared to 22 Non-HR patients. The survival rate (41% vs 30%) was not statistically significant (p = 0.340). However, more bleeding 80% vs 50% recorded in HR (p = 0.043) even though heparin doses between them was not different.
Conclusions
The heparin requirement was high in patients treated with heparin alone. Fresh frozen plasma effectively increased ACT to therapeutic target in HR patients. There was no difference in the heparin dose, significantly higher bleeding complications were recorded in HR patients. Clinically, survival was better in Non-heparin resistance and plasma treated patients that was not found to be statistically significant.
期刊介绍:
The Egyptian Journal of Critical Care Medicine is the official Journal of the Egyptian College of Critical Care Physicians, the most authoritative organization of Egyptian physicians involved in the multi-professional field of critical care medicine. The journal is intended to provide a peer-reviewed source for multidisciplinary coverage of general acute and intensive care medicine and its various subcategories including cardiac, pulmonary, neuro, renal as well as post-operative care. The journal is proud to have an international multi-professional editorial board in the broad field of critical care that will assist in publishing promising research and breakthrough reports that lead to better patients care in life threatening conditions, and bring the reader a quick access to the latest diagnostic and therapeutic approaches in monitoring and management of critically ill patients.