151 DAYS ON ECMO WITH NO HEPARIN

look-ma-no-handsExperimental. On a goat. But still, 151 days on ECMO without any heparinisation is very impressive and promising. One big draw-back of ECMO treatment has been the need for full heparinisation to avoid clotting of the ECMO circuit. Heparin coated circuits have lessened the need for heparinisation, and it’s become routine to run heparin-free for shorter periods if the patient’s bleeding risk demands it.

Shorter heparin-free or low-dose heparin periods are becoming routine in cases where the patient has a coagulopathy or high risk of bleeding. We’ve mentioned it fx in our post on ECMO in trauma. We’ve been able to do this as the heparin coating of the ECMO circuits have gotten better and thus less thrombogenic or coagulation/platelet activating.

There’s an ongoing development in coatings for ECMO circuits to avoid activation of platelets and make them even less thrombogenic. This paper is on one of those coating materials, so we seem to be moving forward. This article is from 2007, so further progress has probably already been made. But we’ll always have to wait for these advances to be approved for human use, but this is a field we might see improvement over the next years.

After the record run, no sign of embolism in the goat’s vessels, and only minor fibrin deposits in the ECMO circuit oxygenator.

Heparin was only added for ECMO initiation (100IU/kg), and micro-doses of heparin entered the blood stream through the art-line set as standard is to keep the art-line open. No heparin could be measured in the blood tests, and ACT was normal throughout the 151 days.

Up to 151 days of continuous animal perfusion with trivial heparin infusion by the application of a long-term durable antithrombogenic coating to a combination of a seal-less centrifugal pump and a diffusion membrane oxygenator, J Artif Organs, 2007.

The system tested here is already in clinical use. Here are a few case reports (thanks, @velianton ):

 

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