Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
Copyright © 2023 Yeungnam University College of Medicine, Yeungnam University Institute of Medical Science
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Funding
None.
Author contributions
Conceptualization, Formal analysis: KS, JBK; Data curation, Investigation, Visualization: KS; Project administration, Supervision: JBK; Writing-original draft: KS; Writing-review & editing: KS, JBK.
Characiteristic | Low-AC group | High-AC group | p-value |
---|---|---|---|
Demographics | |||
No. of patients | 79 | 52 | |
Age (yr) | 60.3±12.1 | 61.3±12.9 | 0.665 |
Male sex | 62 (78.5) | 37 (71.2) | 0.208 |
Body surface area (m2) | 1.73±0.21 | 1.73±0.21 | 0.926 |
Body mass index (kg/m2) | 23.1±3.7 | 24.0±4.1 | 0.172 |
Medication | |||
Aspirin | 38 (48.1) | 23 (44.2) | 0.552 |
Clopidogrel | 34 (43.0) | 21 (40.4) | 0.650 |
Etiology | |||
Ischemic cardiogenic shock | 42 (53.2) | 24 (46.2) | 0.434 |
Comorbidity | |||
Diabetes mellitus | 24 (30.4) | 24 (46.2) | 0.089 |
Hypertension | 34 (43.0) | 29 (55.8) | 0.211 |
Chronic kidney disease | 12 (15.2) | 15 (28.8) | 0.071 |
Respiratory diseases | 11 (13.9) | 11 (21.2) | 0.324 |
Cardiovascular diseases | 59 (74.7) | 36 (69.2) | 0.333 |
Arrhythmia | 14 (17.7) | 3 (5.8) | 0.064 |
Valvular heart diseases | 7 (8.9) | 3 (5.8) | 0.735 |
Cerebrovascular diseases | 10 (12.7) | 6 (11.5) | 0.797 |
Laboratory data | |||
Hemoglobin (g/dL) | 10.0±1.9 | 10.0±2.2 | 0.968 |
Hematocrit (%) | 28.5±5.6 | 29.1±7.1 | 0.608 |
BUN (mg/dL) | 31.2±13.9 | 31.3±14.1 | 0.991 |
Creatinine (mg/dL) | 1.8±1.5 | 1.8±1.5 | 0.963 |
Total bilirubin (mg/dL) | 1.0±0.8 | 1.7±2.0 | 0.007a) |
Platelet count (×103/μL) | 130.2±59.4 | 122.5±80.7 | 0.531 |
WBC count (×103/μL) | 12.4±5.8 | 11.9±5.0 | 0.570 |
aPTT (sec) | 31.9±14.9 | 30.5±13.1 | 0.879 |
Variable | Low-AC group (n=79) | High-AC group (n=52) | p-value |
---|---|---|---|
ECMO time (hr) | 206.3±176.5 | 142.0±126.2 | 0.023a) |
ECMO flow rate (L/min) | 3.0±0.5 | 3.2±0.5 | 0.698 |
Distal perfusion | 15 (19.0) | 17 (32.7) | 0.092 |
Venoarterial ECMO | 70 (88.6) | 47 (90.4) | 0.853 |
ECMO with HD | 20 (25.3) | 27 (51.9) | 0.030a) |
aPTT (sec) | 44.0±12.2 | 90.0±32.4 | <0.001a) |
Primary outcomes | |||
Total adverse event | 3 (3.8) | 8 (15.4) | 0.034a) |
Bleeding event | 2 (2.5) | 8 (15.4) | 0.011a) |
Thrombosis | 1 (1.3) | 0 (0) | >0.999 |
Secondary outcomes | |||
ECMO weaning | 53 (67.1) | 20 (38.5) | 0.001a) |
30-Day mortality | 29 (36.7) | 36 (69.2) | <0.001a) |
Patient No. | Group | Diagnosis | Mean aPTT during ECMO management (sec)a) | Bleeding event | Result of ECMO management |
---|---|---|---|---|---|
1 | Low-AC | AMI | 41.0 | GI bleeding | Survival |
2 | Low-AC | Arrhythmia | 53.3 | ICH | Survival |
3 | High-AC | AMI | 106.3 | GI bleeding | Survival |
4 | High-AC | DCM | 111.6 | SAH | Dead |
5 | High-AC | DCM | 104.5 | GI bleeding | Dead |
6 | High-AC | AMI | 84.2 | GI bleeding | Survival |
7 | High-AC | AMI | 94.8 | Hemothorax | Dead |
8 | High-AC | AMI | 74.7 | Hemothorax | Survival |
9 | High-AC | Arrhythmia | 63.5 | ICH | Dead |
10 | High-AC | AMI | 74.2 | ICH | Survival |
Variable | Patients without anticoagulation (n=32) | Patients with heparinization (n=99) | p-value |
---|---|---|---|
ECMO time (hr) | 208.2±198.8 | 171.3±146.4 | 0.257 |
ECMO flow rate (L/min) | 3.0±0.5 | 3.1±0.5 | 0.187 |
Distal perfusion | 5 (15.6) | 26 (26.3) | 0.338 |
Venoarterial ECMO | 27 (84.4) | 90 (90.9) | 0.330 |
aPTT (sec) | 38.4±16.3 | 70.4±31.9 | <0.001a) |
Primary outcomes | |||
Total adverse event | 0 (0) | 11 (11.1) | 0.072 |
Bleeding event | 0 (0) | 10 (10.1) | 0.122 |
Thrombosis | 0 (0) | 1 (1.0) | >0.999 |
Secondary outcomes | |||
ECMO weaning | 18 (56.3) | 55 (55.6) | 0.954 |
Mortality | 16 (50.0) | 49 (49.5) | 0.963 |
Patients with oxygenator change | |||
ECMO circuit change | 3 (9.4) | 11 (11.1) | >0.999 |
aPTT (sec) | 41.1±4.3 | 54.4±14.1 | 0.021a) |
ECMO flow (L/min) | 3.5±0.6 | 3.3±0.4 | 0.475 |
ECMO time (hr) | 723±120 | 452.4±150.1 | 0.011a) |
Circuit change time (hr) | 223±57 | 211.2±59.9 | 0.574 |
Variable | Group 1 (n=32) | Group 2 (n=47) | Group 3 (n=52) | p-value | ||
---|---|---|---|---|---|---|
Group 1 vs. 2 | Group 2 vs. 3 | Group 1 vs. 3 | ||||
ECMO time (hr) | 208.2±198.8 | 201.6±161.4 | 143.9±126.7 | 0.872 | 0.050a) | 0.112 |
ECMO flow rate (L/min) | 3.0±0.5 | 3.0±0.5 | 3.2±0.5 | 0.653 | 0.135 | 0.072 |
Distal perfusion | 5 (15.6) | 9 (19.1) | 17 (32.2) | 0.684 | 0.119 | 0.084 |
Venoarterial ECMO | 27 (84.4) | 44 (93.6) | 46 (88.5) | 0.248 | 0.489 | 0.743 |
aPTT (sec) | 38.4±16.3 | 48.9±9.4 | 89.8±32.7 | 0.001a) | <0.001a) | <0.001a) |
Primary outcomes | ||||||
Total adverse event | 0 (0) | 3 (6.4) | 8 (15.4) | 0.272 | 0.138 | 0.022a) |
Bleeding event | 0 (0) | 2 (4.3) | 8 (15.4) | 0.345 | 0.102 | 0.018a) |
Thrombosis | 0 (0) | 1(2.1) | 0 (0) | >0.999 | 0.484 | >0.999 |
Secondary outcomes | ||||||
ECMO weaning | 18 (56.3) | 35 (74.5) | 20 (38.5) | 0.090 | 0.001a) | 0.123 |
Mortality | 16 (50.0) | 13 (27.7) | 36 (69.2) | 0.044a) | <0.001a) | 0.069 |
Patient with oxygenator change | ||||||
ECMO circuit change | 3 (9.4) | 7 (14.9) | 4 (7.7) | 0.733 | 0.263 | >0.999 |
aPTT (sec) | 41.1±4.3 | 46.1±9.6 | 68.8±5.4 | 0.424 | 0.002a) | 0.001a) |
ECMO flow (L/min) | 3.5±0.6 | 3.4±0.3 | 3.2±0.3 | 0.682 | 0.432 | 0.464 |
ECMO time (hr) | 723±120 | 443±139 | 468±188 | 0.009a) | 0.922 | 0.113 |
Circuit change time (hr) | 223±57 | 250±57 | 179±58 | 0.658 | 0.161 | 0.218 |
Values are presented as mean±standard deviation or number (%).
Group 1, patients without anticoagulation; Group 2, patients with heparinization but aPTT of <55 sec; Group 3, patients with heparinization and aPTT of ≥55 sec.
aPTT, activated partial thromboplastin time; ECMO, extracorporeal membrane oxygenation.
a)Statistically significant.
Characiteristic | Low-AC group | High-AC group | p-value |
---|---|---|---|
Demographics | |||
No. of patients | 79 | 52 | |
Age (yr) | 60.3±12.1 | 61.3±12.9 | 0.665 |
Male sex | 62 (78.5) | 37 (71.2) | 0.208 |
Body surface area (m2) | 1.73±0.21 | 1.73±0.21 | 0.926 |
Body mass index (kg/m2) | 23.1±3.7 | 24.0±4.1 | 0.172 |
Medication | |||
Aspirin | 38 (48.1) | 23 (44.2) | 0.552 |
Clopidogrel | 34 (43.0) | 21 (40.4) | 0.650 |
Etiology | |||
Ischemic cardiogenic shock | 42 (53.2) | 24 (46.2) | 0.434 |
Comorbidity | |||
Diabetes mellitus | 24 (30.4) | 24 (46.2) | 0.089 |
Hypertension | 34 (43.0) | 29 (55.8) | 0.211 |
Chronic kidney disease | 12 (15.2) | 15 (28.8) | 0.071 |
Respiratory diseases | 11 (13.9) | 11 (21.2) | 0.324 |
Cardiovascular diseases | 59 (74.7) | 36 (69.2) | 0.333 |
Arrhythmia | 14 (17.7) | 3 (5.8) | 0.064 |
Valvular heart diseases | 7 (8.9) | 3 (5.8) | 0.735 |
Cerebrovascular diseases | 10 (12.7) | 6 (11.5) | 0.797 |
Laboratory data | |||
Hemoglobin (g/dL) | 10.0±1.9 | 10.0±2.2 | 0.968 |
Hematocrit (%) | 28.5±5.6 | 29.1±7.1 | 0.608 |
BUN (mg/dL) | 31.2±13.9 | 31.3±14.1 | 0.991 |
Creatinine (mg/dL) | 1.8±1.5 | 1.8±1.5 | 0.963 |
Total bilirubin (mg/dL) | 1.0±0.8 | 1.7±2.0 | 0.007 |
Platelet count (×103/μL) | 130.2±59.4 | 122.5±80.7 | 0.531 |
WBC count (×103/μL) | 12.4±5.8 | 11.9±5.0 | 0.570 |
aPTT (sec) | 31.9±14.9 | 30.5±13.1 | 0.879 |
Variable | Low-AC group (n=79) | High-AC group (n=52) | p-value |
---|---|---|---|
ECMO time (hr) | 206.3±176.5 | 142.0±126.2 | 0.023 |
ECMO flow rate (L/min) | 3.0±0.5 | 3.2±0.5 | 0.698 |
Distal perfusion | 15 (19.0) | 17 (32.7) | 0.092 |
Venoarterial ECMO | 70 (88.6) | 47 (90.4) | 0.853 |
ECMO with HD | 20 (25.3) | 27 (51.9) | 0.030 |
aPTT (sec) | 44.0±12.2 | 90.0±32.4 | <0.001 |
Primary outcomes | |||
Total adverse event | 3 (3.8) | 8 (15.4) | 0.034 |
Bleeding event | 2 (2.5) | 8 (15.4) | 0.011 |
Thrombosis | 1 (1.3) | 0 (0) | >0.999 |
Secondary outcomes | |||
ECMO weaning | 53 (67.1) | 20 (38.5) | 0.001 |
30-Day mortality | 29 (36.7) | 36 (69.2) | <0.001 |
Patient No. | Group | Diagnosis | Mean aPTT during ECMO management (sec) |
Bleeding event | Result of ECMO management |
---|---|---|---|---|---|
1 | Low-AC | AMI | 41.0 | GI bleeding | Survival |
2 | Low-AC | Arrhythmia | 53.3 | ICH | Survival |
3 | High-AC | AMI | 106.3 | GI bleeding | Survival |
4 | High-AC | DCM | 111.6 | SAH | Dead |
5 | High-AC | DCM | 104.5 | GI bleeding | Dead |
6 | High-AC | AMI | 84.2 | GI bleeding | Survival |
7 | High-AC | AMI | 94.8 | Hemothorax | Dead |
8 | High-AC | AMI | 74.7 | Hemothorax | Survival |
9 | High-AC | Arrhythmia | 63.5 | ICH | Dead |
10 | High-AC | AMI | 74.2 | ICH | Survival |
Variable | Patients without anticoagulation (n=32) | Patients with heparinization (n=99) | p-value |
---|---|---|---|
ECMO time (hr) | 208.2±198.8 | 171.3±146.4 | 0.257 |
ECMO flow rate (L/min) | 3.0±0.5 | 3.1±0.5 | 0.187 |
Distal perfusion | 5 (15.6) | 26 (26.3) | 0.338 |
Venoarterial ECMO | 27 (84.4) | 90 (90.9) | 0.330 |
aPTT (sec) | 38.4±16.3 | 70.4±31.9 | <0.001 |
Primary outcomes | |||
Total adverse event | 0 (0) | 11 (11.1) | 0.072 |
Bleeding event | 0 (0) | 10 (10.1) | 0.122 |
Thrombosis | 0 (0) | 1 (1.0) | >0.999 |
Secondary outcomes | |||
ECMO weaning | 18 (56.3) | 55 (55.6) | 0.954 |
Mortality | 16 (50.0) | 49 (49.5) | 0.963 |
Patients with oxygenator change | |||
ECMO circuit change | 3 (9.4) | 11 (11.1) | >0.999 |
aPTT (sec) | 41.1±4.3 | 54.4±14.1 | 0.021 |
ECMO flow (L/min) | 3.5±0.6 | 3.3±0.4 | 0.475 |
ECMO time (hr) | 723±120 | 452.4±150.1 | 0.011 |
Circuit change time (hr) | 223±57 | 211.2±59.9 | 0.574 |
Variable | Group 1 (n=32) | Group 2 (n=47) | Group 3 (n=52) | p-value | ||
---|---|---|---|---|---|---|
Group 1 vs. 2 | Group 2 vs. 3 | Group 1 vs. 3 | ||||
ECMO time (hr) | 208.2±198.8 | 201.6±161.4 | 143.9±126.7 | 0.872 | 0.050 |
0.112 |
ECMO flow rate (L/min) | 3.0±0.5 | 3.0±0.5 | 3.2±0.5 | 0.653 | 0.135 | 0.072 |
Distal perfusion | 5 (15.6) | 9 (19.1) | 17 (32.2) | 0.684 | 0.119 | 0.084 |
Venoarterial ECMO | 27 (84.4) | 44 (93.6) | 46 (88.5) | 0.248 | 0.489 | 0.743 |
aPTT (sec) | 38.4±16.3 | 48.9±9.4 | 89.8±32.7 | 0.001 |
<0.001 |
<0.001 |
Primary outcomes | ||||||
Total adverse event | 0 (0) | 3 (6.4) | 8 (15.4) | 0.272 | 0.138 | 0.022 |
Bleeding event | 0 (0) | 2 (4.3) | 8 (15.4) | 0.345 | 0.102 | 0.018 |
Thrombosis | 0 (0) | 1(2.1) | 0 (0) | >0.999 | 0.484 | >0.999 |
Secondary outcomes | ||||||
ECMO weaning | 18 (56.3) | 35 (74.5) | 20 (38.5) | 0.090 | 0.001 |
0.123 |
Mortality | 16 (50.0) | 13 (27.7) | 36 (69.2) | 0.044 |
<0.001 |
0.069 |
Patient with oxygenator change | ||||||
ECMO circuit change | 3 (9.4) | 7 (14.9) | 4 (7.7) | 0.733 | 0.263 | >0.999 |
aPTT (sec) | 41.1±4.3 | 46.1±9.6 | 68.8±5.4 | 0.424 | 0.002 |
0.001 |
ECMO flow (L/min) | 3.5±0.6 | 3.4±0.3 | 3.2±0.3 | 0.682 | 0.432 | 0.464 |
ECMO time (hr) | 723±120 | 443±139 | 468±188 | 0.009 |
0.922 | 0.113 |
Circuit change time (hr) | 223±57 | 250±57 | 179±58 | 0.658 | 0.161 | 0.218 |
Values are presented as number only, mean±standard deviation, or number (%). AC, anticoagulation; BUN, blood urea nitrogen; WBC, white blood cell; aPTT, activated partial thromboplastin time. Statistically significant.
Values are presented as mean±standard deviation or number (%). AC, anticoagulation; ECMO, extracorporeal membrane oxygenation; HD, hemodialysis; aPTT, activated partial thromboplastin time. Statistically significant.
aPTT, activated partial thromboplastin time; ECMO, extracorporeal membrane oxygenation; AC, anticoagulation; AMI, acute myocardial infarction; GI, gastrointestinal; ICH, intracerebral hemorrhage; DCM, dilated cardiomyopathy; SAH, subarachnoid hemorrhage. Until primary endpoint.
Values are presented as mean±standard deviation or number (%). ECMO, extracorporeal membrane oxygenation; aPTT, activated partial thromboplastin time. Statistically significant.
Values are presented as mean±standard deviation or number (%). Group 1, patients without anticoagulation; Group 2, patients with heparinization but aPTT of <55 sec; Group 3, patients with heparinization and aPTT of ≥55 sec. aPTT, activated partial thromboplastin time; ECMO, extracorporeal membrane oxygenation. Statistically significant.