Tuberc Respir Dis.  2015 Jan;78(1):18-22. 10.4046/trd.2015.78.1.18.

Thrombotic Complications during Interventional Lung Assist: Case Series

Affiliations
  • 1Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea. popeyes0212@hanmail.net
  • 2Department of Cardiovascular and Thoracic Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.

Abstract

Interventional lung assist (iLA) effectively reduces CO2 retention and allows protective ventilation in cases of life-threatening hypercapnia. Despite the clinical efficacy of iLA, there are a few major limitations associated with the use of this approach, such as bleeding, thrombosis, and catheter-related limb ischemia. We presented two cases in which thrombotic complications developed during iLA. We demonstrated the two possible causes of thrombotic complications during iLA; stasis due to low blood flow and inadequate anticoagulation.

Keyword

Lung; Complications; Thrombosistal

MeSH Terms

Extremities
Hemorrhage
Hypercapnia
Ischemia
Lung*
Thrombosis
Ventilation

Figure

  • Figure 1 Case 1. Clots in the circuit.

  • Figure 2 Case 2. Chest spiral computed tomography scan showing filling defect at pulmonary artery (arrow).


Reference

1. Tao W, Brunston RL Jr, Bidani A, Pirtle P, Dy J, Cardenas VJ Jr, et al. Significant reduction in minute ventilation and peak inspiratory pressures with arteriovenous CO2 removal during severe respiratory failure. Crit Care Med. 1997; 25:689–695.
2. Liebold A, Reng CM, Philipp A, Pfeifer M, Birnbaum DE. Pumpless extracorporeal lung assist: experience with the first 20 cases. Eur J Cardiothorac Surg. 2000; 17:608–613.
3. Bein T, Weber F, Philipp A, Prasser C, Pfeifer M, Schmid FX, et al. A new pumpless extracorporeal interventional lung assist in critical hypoxemia/hypercapnia. Crit Care Med. 2006; 34:1372–1377.
4. Zick G, Frerichs I, Schadler D, Schmitz G, Pulletz S, Cavus E, et al. Oxygenation effect of interventional lung assist in a lavage model of acute lung injury: a prospective experimental study. Crit Care. 2006; 10:R56.
5. Zimmermann M, Bein T, Arlt M, Philipp A, Rupprecht L, Mueller T, et al. Pumpless extracorporeal interventional lung assist in patients with acute respiratory distress syndrome: a prospective pilot study. Crit Care. 2009; 13:R10.
6. Jayroe JB, Wang D, Deyo DJ, Alpard SK, Bidani A, Zwischenberger JB. The effect of augmented hemodynamics on blood flow during arteriovenous carbon dioxide removal. ASAIO J. 2003; 49:30–34.
7. Cho WH, Lee K, Huh JW, Lim CM, Koh Y, Hong SB. Physiologic effect and safety of the pumpless extracorporeal interventional lung assist system in patients with acute respiratory failure: a pilot study. Artif Organs. 2012; 36:434–438.
8. Bein T, Zimmermann M, Philipp A, Ramming M, Sinner B, Schmid C, et al. Addition of acetylsalicylic acid to heparin for anticoagulation management during pumpless extracorporeal lung assist. ASAIO J. 2011; 57:164–168.
9. Villaneuva GB, Danishefsky I. Evidence for a heparin-induced conformational change on antithrombin III. Biochem Biophys Res Commun. 1977; 74:803–809.
10. Oliver WC. Anticoagulation and coagulation management for ECMO. Semin Cardiothorac Vasc Anesth. 2009; 13:154–175.
Full Text Links
  • TRD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr