Outcomes of Adult Venovenous Extracorporeal Membrane Oxygenation Patients without Anticoagulation: A Retrospective Review at a Tertiary Level Referral Center.

Introduction Extracorporeal membrane oxygenation (ECMO) provides cardiopulmonary support for patients with acute respiratory and/or cardiac failure. Patients are therapeutically anticoagulated with heparin to prevent thrombi from forming in the extensive conduit, centrifugal pump, or oxygenator-circuit systems. Heparin use is interrupted if life threatening bleeding develops. We examined outcomes for adult patients on venovenous ECMO who had their heparin interrupted compared with those who did not. Methods A single institution retrospective study was performed for adult patients on venovenous ECMO from 2013 to 2015. Patients whose heparin was interrupted for ≥24 hours were compared with those with uninterrupted heparin use. Results There were 64 patients, 34 of whom had at least 1 heparin interruption meeting the criteria. Patients in the interruption group had significantly longer duration of ECMO (19.4 vs 8.8 days, p=0.001), developed more deep vein thrombosis (DVT) (35.3% vs 13.3%, p=0.043), and had an increased mortality rate (47.1% vs 23.3%, p=0.049). The rate of deaths per day on ECMO was almost identical between the 2 groups (0.024 vs 0.026). No death was attributable to thromboembolism; the majority of deaths were due to worsening multiorgan system failure (Table)