FEMORAL VENOARTERIAL EXTRACORPOREAL LIFE-SUPPORT WITH MINIMAL OR NO HEPARIN

Recent technological advances in cardiopulmonary bypass circuits achie ving surface bonding with heparin have permitted prolonged extracorpor eal life support (ECLS) in experimental studies without the use of sys temic anticoagulation. Excessive bleeding and the need for massive tra nsfusions after extended ECLS with systemic heparinization have often led to the development of sepsis and multisystem organ failure. The Ca rmeda bioactive surface circuit, along with a Bio-Medicus centrifugal pump (Bio-Pump) and the femoral veno-arterial route, were used success fully in 3 patients requiring ECLS between April 1992 and December 199 2. In 2 patients the need for ECLS was acute allograft dysfunction aft er orthotopic cardiac transplantation with no evidence of cellular rej ection. Both patients were receiving multiple inotropes and intraaorti c balloon counterpulsation; their condition continued to deteriorate r apidly before the initiation of ECLS. The third patient failed to be w eaned from cardiopulmonary bypass after myocardial revascularization f or ischemic cardiomyopathy. Time on ECLS ranged from 57 to 128 hours. No systemic anticoagulation was used. One patient received no heparin, and the other 2 patients received intermittent heparin infusion to ma intain an average activated clotting time of 195 and 214 seconds. Mult isystem organ dysfunction present before initiation of ECLS was rapidl y reversed, and all patients were weaned successfully without any imme diate major complications. The ability to conduct prolonged ECLS witho ut systemic anticoagulation and without repeat sternotomy opens new av enues for the use of this procedure in profound heart failure.