COAGULATION-FACTOR DEFICIENCIES DURING INITIATION OF EXTRACORPOREAL MEMBRANE-OXYGENATION

Objective: We examined the hypothesis that critically ill patients rec eiving extracorporeal membrane oxygenation (ECMO) have reduced clottin g factor levels, which may contribute to the risk of hemorrhagic compl ications. Methods: Blood samples were collected from 19 patients befor e and 1 hour after initiation of ECMO, Heparin present in samples was removed by ECTEOLA (epichlorohydrin triethanolamine) cellulose resin a dsorption, and coagulation factors were assayed by automated technique s. Factor deficiency was defined as levels at least 2 SD less than pub lished age-adjusted reference values. Results: Thirteen patients (68%) had deficiencies of two or more factors before ECMO. Despite inclusio n of factor-containing blood products in the ECMO priming solution, 10 patients (53%) had deficiencies of two or more factors after initiati on of ECMO. Four patients had intracranial hemorrhages and were found to be deficient in five or more factors at the time of cannulation. Co nclusions: Severe coagulation factor deficiencies are often present in patients requiring ECMO, and coagulation factors provided through the circuit prime are insufficient to ensure correction of these deficien cies, Deficiency of multiple coagulation factors may contribute to the risk of intracranial hemorrhage during ECMO; the practice of excludin g factor-containing solutions from the circuit prime should be examine d prospectively.