Coagulation Disorders in Subjects Undergoing Pump-Driven Veno-Venous Ecco2-R For Severe Acute Hypercapnic Respiratory Failure - a Single Center Experience

Introduction

Recent evidence suggests low-flow extracorporeal CO2 removal (ECCO2-R) systems as safe and promising adjunctive therapy to avoid endotracheal intubation and the related negative consequences in subjects with severe hypercapnic respiratory failure [1]. in high-flow extracorporeal membrane oxygenation systems heterogeneous coagulation disorders are a well-known complication. However, to date there is little evidence for the influence of pump-driven low-flow veno-venous ECCO2-R on the coagulation system.

Objectives

This study is a retrospective analysis of four subjects developing coagulation disorders with bleeding complications while undergoing ECCO2-R.

Methods

Four subjects treated with a pump-driven veno-venous ECCO2-R (system: iLA Activve®; membrane ventilator: Minilung®; Novalung GmbH, Talheim, Germany) for severe hypercapnic respiratory failure due to acute exacerbation of COPD were included in this study. Unfractionated heparin was used for anticoagulation with a target aPTT of 45-55 sec. Coagulation parameters i.e. hemoglobin, platelets, fibrinogen, antithrombin and D-DIMER were retrieved from the charts at treatment initiation and during the time range starting 72 hours before and ending at the clinical onset of the bleeding complication.

Results

Mean application time of ECCO2-R was 196.5 h ( ± 77.4) with an average blood flow of 1.1 l/min ( ± 0.2). Bleeding events consisted of two pulmonary bleedings, one large soft tissue hematoma and one hemothorax. Coagulation parameters are depicted below in Table 1. ECCO2-R was removed in all subjects after onset of the bleeding complication resulting in stabilization of the coagulation state.

Table 1 Coagulation parameters.

Conclusions

Despite adequate anticoagulation subjects undergoing pump-driven veno-venous ECCO2-R developed coagulation disorders similar to disseminated intravascular coagulation with concomitant bleeding complications. the underlying mechanism remains to be clarified.