Issue |
J Extra Corpor Technol
Volume 56, Number 3, September 2024
|
|
---|---|---|
Page(s) | 108 - 113 | |
DOI | https://doi.org/10.1051/ject/2024022 | |
Published online | 20 September 2024 |
Original Article
Increased white blood cell count is associated with an increased demand for unfractionated heparin during veno-arterial extracorporeal oxygenation in lung transplantation
1
Department of Clinical Engineering, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-city, Tokyo 113-8655, Japan
2
Department of Anesthesiology, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-city, Tokyo 113-8655, Japan
3
Department of Thoracic Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-city, Tokyo 113-8655, Japan
* Corresponding author: kashiwak-sup@h.u-tokyo.ac.jp
Received:
8
April
2024
Accepted:
22
July
2024
Background: This retrospective observational study aimed to examine whether clinical inflammatory parameters were associated with the requirement dosage of unfractionated heparin (UFH) to maintain the range of ACT in veno-arterial extracorporeal membrane oxygenation (V-A ECMO) during lung transplantation surgery. Methods: Among all patients who underwent lung transplantation using V-A ECMO from January 2021 to May 2022, 27 patients were included. These patients were divided into two groups based on whether the infusion rate of UFH was increased from the initial infusion rate (7–8 units/kg/h) (increased group, n = 10) or the infusion rate was maintained or decreased (non-increased group, n = 17). The infusion rate was adjusted with an activated clotting time (ACT) target of 160–200 s. Results: At 1–2 h after starting ECMO, ACT was significantly lower (179.0 (166.5–188.5) versus 224.0 (193.0–242.0) sec, p = 0.006) and white blood cell (WBC) counts were higher in the increased group (12.6 ± 3.3 versus 9.5 ± 4.0 × 103/μL, p = 0.046). The UFH infusion rates were higher in the increased group during the surgery. The cutoff value of WBC count at 1–2 h after starting ECMO for discriminating the need for increasing the UFH dosage was determined as 10.2 × 103/μL (sensitivity 90.0%, specificity 58.8%, area under the curve 0.712) and discrimination of this cut-off value was confirmed as statistically significant (p = 0.018). Conclusion: These data suggested that WBC count was associated with the requirement of an increase in the UFH infusion rate of V-A ECMO during lung transplantation surgery. Further evaluation is necessary to clarify the role of WBC count in determining the optimal UFH dosage.
Key words: Veno-arterial extracorporeal membrane oxygenation / Lung transplantation / Unfractionated heparin / White blood cell
© The Author(s), published by EDP Sciences, 2024
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Current usage metrics show cumulative count of Article Views (full-text article views including HTML views, PDF and ePub downloads, according to the available data) and Abstracts Views on Vision4Press platform.
Data correspond to usage on the plateform after 2015. The current usage metrics is available 48-96 hours after online publication and is updated daily on week days.
Initial download of the metrics may take a while.