• Norihisa Yasuda, Koji Goto, Takayuki Mizoguchi, Yoshifumi Ohchi, Shin-Ichi Nureki, and Takaaki Kitano.
• Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Oita, Japan. yasu@oita-u.ac.jp.
• Ann Palliat Med. 2021 Feb 1; 10 (2): 1834-1841.

BackgroundDuring veno-venous extracorporeal membrane oxygenation (VV-ECMO), systemic anticoagulation is required to prevent thrombotic complications within the circuit and oxygenator. The unfractionated heparin (UFH) is commonly administered as a standard anticoagulant, but in our institute recombinant human thrombomodulin (rhTM), instead of UFH, is used as an anticoagulant for VV-ECMO. In the present study, we reviewed whether rhTM could be applied effectively and safely as an anticoagulant agent during VV-ECMO.MethodsAll 15 patients with severe respiratory failure on VV-ECMO were analyzed retrospectively. The following data were collected: age, gender, underlying disease, APACHE-II score, SOFA score, Japanese association for acute medicine (JAAM) DIC score, the usage of anticoagulants, time course of coagulationrelated parameters during ECMO, hemorrhagic and thrombotic complications.ResultsThe median age of the patients was 73 years. The median JAAM DIC score at day 0 was 5 points, indicating that 13 patients were diagnosed with DIC at the initiation of VV-ECMO. The total number of days of VV-ECMO runs combined was 193 days, with a median duration of VV-ECMO of 9 days. Among the 15 VV-ECMO runs, rhTM was used as monotherapy in 5 runs, and a combination of rhTM and (antithrombin) AT was used in 8 runs. UFH was used in combination with rhTM in only 2 runs. Median ACT and aPTT remained a little longer than normal range over the course of the 14 days of a VV-ECMO run. Bleeding events were observed in 6 cases (40%) and no major thromboses were observed in all patients.ConclusionsIn this retrospective study, we analyzed 15 patients with severe respiratory failure who were administered rhTM as an anticoagulant during VV-ECMO and found that anticoagulation therapy with rhTM is maybe a feasible option which allows for effective and safe VV-ECMO.

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