PDF(Pubmed)
Abstract：
Background: Extracorporeal membrane oxygenation (ECMO) is frequently used during lung transplantation. Unfractionated heparin (UFH) is mainly used as part of ECMO support for anticoagulation. One of the most common perioperative complications is bleeding, which high-dose UFH can aggravate. Methods: We retrospectively analyzed (n = 141) patients who underwent lung transplantation between 2020 and 2022. All subjects (n = 109) underwent central cannulated VA ECMO with successful intraoperative ECMO weaning. Patients on ECMO bridge, postoperative ECMO, heart-lung transplants and transplants without ECMO were excluded. The dose of UFH for the entire surgical procedure, blood loss and consumption of blood derivatives intraoperatively and 48 h after ICU admission were recorded. Surgical revision for postoperative bleeding were analyzed. Thrombotic complications, mortality and long-term survival were evaluated. Results: Lower doses of UFH administered for intraoperative ECMO anticoagulation contribute to a reduction in intraoperative blood derivates consumption and blood loss with no thrombotic complications related to the patient or the ECMO circuit. Lower doses of UFH may lead to a decreased incidence of surgical revision for hemothorax. Conclusion: Lower doses of UFH as part of intraoperative ECMO anticoagulation might reduce the incidence of complications and lead to better postoperative outcomes.
摘要：
背景：体外膜氧合（ECMO）在肺移植中经常使用。普通肝素（UFH）主要用作ECMO抗凝支持的一部分。围手术期最常见的并发症之一是出血，高剂量UFH可加重。方法：我们回顾性分析了（n=141）在2020年至2022年间接受肺移植的患者。所有受试者（n=109）均接受了中央插管VAECMO，并成功进行了术中ECMO撤机。ECMO桥上的病人,术后ECMO,我们排除了心肺移植和无ECMO的移植.整个外科手术的UFH剂量,记录术中和ICU入院后48h的失血量和血液衍生物的消耗量.对手术翻修术后出血情况进行分析。血栓并发症，评估了死亡率和长期生存率.结果：用于术中ECMO抗凝的较低剂量的UFH有助于减少术中血液衍生物的消耗和失血，而没有与患者或ECMO回路相关的血栓性并发症。较低剂量的UFH可能导致血胸手术翻修的发生率降低。结论：较低剂量的UFH作为术中ECMO抗凝的一部分，可降低并发症的发生率，并导致更好的术后预后。
