Extracorporeal arteriovenous CO2 removal for severe respiratory failure

high versus low dose heparin

Clare Savage, Scott K. Alpard, Jennifer Murphy, Donald J. Deyo, Jason B. Jayroe, Joseph B. Zwischenberger

    Research output: Contribution to journalArticle

    1 Citation (Scopus)

    Abstract

    Objective: In prior studies, we established the safety and feasibility of percutaneous arteriovenous CO2 removal (AVCO2R) for severe respiratory failure using high dose heparin to minimize thrombosis with activated clotting times (ACT) > 300 sec (sheep) and > 260 sec (humans). We conducted a prospective randomized study of AVCO2R utilizing a new, commercially available, heparin-coated oxygenator comparing low dose heparin (< 200 sec) with high dose heparin (> 300 sec). Methods: Adult Suffolk ewes (n=10) received a combination cotton smoke inhalation (36 breaths) and cutaneous flame burn (40% TBSA III°) injury, with volume controlled mechanical ventilation. When animals met entry criteria for AEDS (P/F ratio < 200) they were re-anesthetized, systemically anticoagulated (200 IU/kg bovine lung heparin) and underwent cannulation of the left carotid artery (percutaneous 10-12F) and left jugular vein (percutaneous 14F). The AVCO2R circuit included a Trillium® Biopassive Surface coated, low resistance membrane gas exchanger (Affinity, Avecor Cardiovascular, Plymouth, MN). Animals randomly received LOW DOSE (n=5, ACT < 200 sec) or HIGH DOSE heparin (n=5, ACT > 300 sec). ACT was measured hourly while prothrombin time, activated partial thromboplastin time, fibrinogen, FDP, and platelets were measured every 12 hours. Results: For the HIGH DOSE group, ACT values ranged from 336 ± 81 to 448 ± 100 sec with an overall average of 415 ± 27 sec. The LOW DOSE ACT ranged from 173 ± 8 to 241 ± 39 sec with an overall average of 192 ± 6 sec. Mean flow through the oxygenator was similar in both groups, ranging from 813 ± 150 ml/min to 922 ± 138 ml/min and from 862 ± 115 ml/min to 932 ± 84 ml/min in the HIGH and LOW dose groups, respectively. Coagulation parameters, measured by prothrombin time, activated partial thromboplastin time, fibrinogen and FDP remained within physiologic range for both groups and no difference between groups was observed. No evidence of thrombosis or hemorrhage was observed from the cannulation sites or systemically. Conclusion: Low dose systemic heparin (ACT < 200 sec) with a heparin-coated oxygenator does not increase thrombogenicity during AVCO 2R for ARDS.

    Original languageEnglish (US)
    JournalCritical Care Medicine
    Volume27
    Issue number12 SUPPL.
    StatePublished - 1999

    Fingerprint

    Respiratory Insufficiency
    Heparin
    Oxygenators
    Partial Thromboplastin Time
    Prothrombin Time
    Fibrinogen
    Thrombosis
    Artificial Respiration
    Smoke
    Catheterization
    Inhalation
    Sheep
    Blood Platelets
    Prospective Studies
    Hemorrhage
    Safety
    Skin
    Wounds and Injuries
    formycin diphosphate

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine

    Cite this

    Savage, C., Alpard, S. K., Murphy, J., Deyo, D. J., Jayroe, J. B., & Zwischenberger, J. B. (1999). Extracorporeal arteriovenous CO2 removal for severe respiratory failure: high versus low dose heparin. Critical Care Medicine, 27(12 SUPPL.).

    Extracorporeal arteriovenous CO2 removal for severe respiratory failure : high versus low dose heparin. / Savage, Clare; Alpard, Scott K.; Murphy, Jennifer; Deyo, Donald J.; Jayroe, Jason B.; Zwischenberger, Joseph B.

    In: Critical Care Medicine, Vol. 27, No. 12 SUPPL., 1999.

    Research output: Contribution to journalArticle

    Savage, C, Alpard, SK, Murphy, J, Deyo, DJ, Jayroe, JB & Zwischenberger, JB 1999, 'Extracorporeal arteriovenous CO2 removal for severe respiratory failure: high versus low dose heparin', Critical Care Medicine, vol. 27, no. 12 SUPPL..
    Savage C, Alpard SK, Murphy J, Deyo DJ, Jayroe JB, Zwischenberger JB. Extracorporeal arteriovenous CO2 removal for severe respiratory failure: high versus low dose heparin. Critical Care Medicine. 1999;27(12 SUPPL.).
    Savage, Clare ; Alpard, Scott K. ; Murphy, Jennifer ; Deyo, Donald J. ; Jayroe, Jason B. ; Zwischenberger, Joseph B. / Extracorporeal arteriovenous CO2 removal for severe respiratory failure : high versus low dose heparin. In: Critical Care Medicine. 1999 ; Vol. 27, No. 12 SUPPL.
    @article{9eaa1218c2144699ab04f072ec854b7c,
    title = "Extracorporeal arteriovenous CO2 removal for severe respiratory failure: high versus low dose heparin",
    abstract = "Objective: In prior studies, we established the safety and feasibility of percutaneous arteriovenous CO2 removal (AVCO2R) for severe respiratory failure using high dose heparin to minimize thrombosis with activated clotting times (ACT) > 300 sec (sheep) and > 260 sec (humans). We conducted a prospective randomized study of AVCO2R utilizing a new, commercially available, heparin-coated oxygenator comparing low dose heparin (< 200 sec) with high dose heparin (> 300 sec). Methods: Adult Suffolk ewes (n=10) received a combination cotton smoke inhalation (36 breaths) and cutaneous flame burn (40{\%} TBSA III°) injury, with volume controlled mechanical ventilation. When animals met entry criteria for AEDS (P/F ratio < 200) they were re-anesthetized, systemically anticoagulated (200 IU/kg bovine lung heparin) and underwent cannulation of the left carotid artery (percutaneous 10-12F) and left jugular vein (percutaneous 14F). The AVCO2R circuit included a Trillium{\circledR} Biopassive Surface coated, low resistance membrane gas exchanger (Affinity, Avecor Cardiovascular, Plymouth, MN). Animals randomly received LOW DOSE (n=5, ACT < 200 sec) or HIGH DOSE heparin (n=5, ACT > 300 sec). ACT was measured hourly while prothrombin time, activated partial thromboplastin time, fibrinogen, FDP, and platelets were measured every 12 hours. Results: For the HIGH DOSE group, ACT values ranged from 336 ± 81 to 448 ± 100 sec with an overall average of 415 ± 27 sec. The LOW DOSE ACT ranged from 173 ± 8 to 241 ± 39 sec with an overall average of 192 ± 6 sec. Mean flow through the oxygenator was similar in both groups, ranging from 813 ± 150 ml/min to 922 ± 138 ml/min and from 862 ± 115 ml/min to 932 ± 84 ml/min in the HIGH and LOW dose groups, respectively. Coagulation parameters, measured by prothrombin time, activated partial thromboplastin time, fibrinogen and FDP remained within physiologic range for both groups and no difference between groups was observed. No evidence of thrombosis or hemorrhage was observed from the cannulation sites or systemically. Conclusion: Low dose systemic heparin (ACT < 200 sec) with a heparin-coated oxygenator does not increase thrombogenicity during AVCO 2R for ARDS.",
    author = "Clare Savage and Alpard, {Scott K.} and Jennifer Murphy and Deyo, {Donald J.} and Jayroe, {Jason B.} and Zwischenberger, {Joseph B.}",
    year = "1999",
    language = "English (US)",
    volume = "27",
    journal = "Critical Care Medicine",
    issn = "0090-3493",
    publisher = "Lippincott Williams and Wilkins",
    number = "12 SUPPL.",

    }

    TY - JOUR

    T1 - Extracorporeal arteriovenous CO2 removal for severe respiratory failure

    T2 - high versus low dose heparin

    AU - Savage, Clare

    AU - Alpard, Scott K.

    AU - Murphy, Jennifer

    AU - Deyo, Donald J.

    AU - Jayroe, Jason B.

    AU - Zwischenberger, Joseph B.

    PY - 1999

    Y1 - 1999

    N2 - Objective: In prior studies, we established the safety and feasibility of percutaneous arteriovenous CO2 removal (AVCO2R) for severe respiratory failure using high dose heparin to minimize thrombosis with activated clotting times (ACT) > 300 sec (sheep) and > 260 sec (humans). We conducted a prospective randomized study of AVCO2R utilizing a new, commercially available, heparin-coated oxygenator comparing low dose heparin (< 200 sec) with high dose heparin (> 300 sec). Methods: Adult Suffolk ewes (n=10) received a combination cotton smoke inhalation (36 breaths) and cutaneous flame burn (40% TBSA III°) injury, with volume controlled mechanical ventilation. When animals met entry criteria for AEDS (P/F ratio < 200) they were re-anesthetized, systemically anticoagulated (200 IU/kg bovine lung heparin) and underwent cannulation of the left carotid artery (percutaneous 10-12F) and left jugular vein (percutaneous 14F). The AVCO2R circuit included a Trillium® Biopassive Surface coated, low resistance membrane gas exchanger (Affinity, Avecor Cardiovascular, Plymouth, MN). Animals randomly received LOW DOSE (n=5, ACT < 200 sec) or HIGH DOSE heparin (n=5, ACT > 300 sec). ACT was measured hourly while prothrombin time, activated partial thromboplastin time, fibrinogen, FDP, and platelets were measured every 12 hours. Results: For the HIGH DOSE group, ACT values ranged from 336 ± 81 to 448 ± 100 sec with an overall average of 415 ± 27 sec. The LOW DOSE ACT ranged from 173 ± 8 to 241 ± 39 sec with an overall average of 192 ± 6 sec. Mean flow through the oxygenator was similar in both groups, ranging from 813 ± 150 ml/min to 922 ± 138 ml/min and from 862 ± 115 ml/min to 932 ± 84 ml/min in the HIGH and LOW dose groups, respectively. Coagulation parameters, measured by prothrombin time, activated partial thromboplastin time, fibrinogen and FDP remained within physiologic range for both groups and no difference between groups was observed. No evidence of thrombosis or hemorrhage was observed from the cannulation sites or systemically. Conclusion: Low dose systemic heparin (ACT < 200 sec) with a heparin-coated oxygenator does not increase thrombogenicity during AVCO 2R for ARDS.

    AB - Objective: In prior studies, we established the safety and feasibility of percutaneous arteriovenous CO2 removal (AVCO2R) for severe respiratory failure using high dose heparin to minimize thrombosis with activated clotting times (ACT) > 300 sec (sheep) and > 260 sec (humans). We conducted a prospective randomized study of AVCO2R utilizing a new, commercially available, heparin-coated oxygenator comparing low dose heparin (< 200 sec) with high dose heparin (> 300 sec). Methods: Adult Suffolk ewes (n=10) received a combination cotton smoke inhalation (36 breaths) and cutaneous flame burn (40% TBSA III°) injury, with volume controlled mechanical ventilation. When animals met entry criteria for AEDS (P/F ratio < 200) they were re-anesthetized, systemically anticoagulated (200 IU/kg bovine lung heparin) and underwent cannulation of the left carotid artery (percutaneous 10-12F) and left jugular vein (percutaneous 14F). The AVCO2R circuit included a Trillium® Biopassive Surface coated, low resistance membrane gas exchanger (Affinity, Avecor Cardiovascular, Plymouth, MN). Animals randomly received LOW DOSE (n=5, ACT < 200 sec) or HIGH DOSE heparin (n=5, ACT > 300 sec). ACT was measured hourly while prothrombin time, activated partial thromboplastin time, fibrinogen, FDP, and platelets were measured every 12 hours. Results: For the HIGH DOSE group, ACT values ranged from 336 ± 81 to 448 ± 100 sec with an overall average of 415 ± 27 sec. The LOW DOSE ACT ranged from 173 ± 8 to 241 ± 39 sec with an overall average of 192 ± 6 sec. Mean flow through the oxygenator was similar in both groups, ranging from 813 ± 150 ml/min to 922 ± 138 ml/min and from 862 ± 115 ml/min to 932 ± 84 ml/min in the HIGH and LOW dose groups, respectively. Coagulation parameters, measured by prothrombin time, activated partial thromboplastin time, fibrinogen and FDP remained within physiologic range for both groups and no difference between groups was observed. No evidence of thrombosis or hemorrhage was observed from the cannulation sites or systemically. Conclusion: Low dose systemic heparin (ACT < 200 sec) with a heparin-coated oxygenator does not increase thrombogenicity during AVCO 2R for ARDS.

    UR - http://www.scopus.com/inward/record.url?scp=4243466226&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=4243466226&partnerID=8YFLogxK

    M3 - Article

    VL - 27

    JO - Critical Care Medicine

    JF - Critical Care Medicine

    SN - 0090-3493

    IS - 12 SUPPL.

    ER -