Incidence of Cannula-Associated Deep Vein Thrombosis After Veno-Venous Extracorporeal Membrane Oxygenation

Abstract

Limited literature regarding the incidence of cannula-associated deep vein thrombosis (CaDVT) after veno-venous extracorporeal membrane oxygenation (VV ECMO) exists. The purpose of this study was to identify the incidence of post decannulation CaDVT and identify any associated risk factors. Forty-eight patients were admitted between August 2014 and January 2016 to the Lung Rescue Unit were included in the study. Protocolized anticoagulation levels (partial thromboplastin time [PTT] 45-55 seconds) and routine post decannulation DVT screening were in place during the study period. Forty-one (85.4%) patients had CaDVT. Of those with CaDVT, 31 (76%) patients were treated with full anti-coagulation therapy. Thirty-four (76%) patients with right internal jugular (RIJ) cannulation had CaDVT at cannula site. Twenty-five (61%) patients had CaDVT in the lower extremity (18 associated right femoral vein cannulation and 7 left femoral vein cannulation). Eighteen (44%) patients had both upper and lower extremity CaDVT. Overall, patients with CaDVT tended to be older, have a higher body mass index (BMI), and on ECMO longer (p = NS). Mean PTT during time on ECMO between patients that did and did not have CaDVT did not differ. No clinical evidence of pulmonary embolism (PE) was seen.

Venous Thromboembolism Events Following Venovenous Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Syndrome Coronavirus 2 Based on CT Scans

“…The incidence of CaDVT varies between 18.1% and 85.4% according to diagnostic methods (7,10,11), and recently we have reported a prevalence of 71.4% when using exclusively a CT scan for diagnosis (8) which is consistent with the present results. When compared with the influenza group, we found a higher prevalence of CaDVT in the SARS-CoV-2 group, but the difference was not statistically significant, probably due to a lack of power (84.6% vs 60%, respectively).…”

“…Therefore, close monitoring of anticoagulation with a higher target than usual, especially in patients with risk factors for thrombosis and/or elevated d-dimer, is suggested (4). During venovenous ECMO, the occurrence of venous thromboembolism has been studied, with an incidence of up to 85% of cases (7). In SARS-CoV-2 patients requiring venovenous ECMO, the prevalence of venous thromboembolism events has only been investigated using ultrasonography.…”

Large Dual-Lumen Extracorporeal Membrane Oxygenation Cannulas Are Associated with More Intracranial Hemorrhage

“…13 Cannula associated DVT is also common occurring in up to 85% of ECMO patients. 5 There are no animal studies confirming that VV ECMO cannulas cause venous congestion in the brain, but it is reasonable to assume that they increase cerebral venous pressure, as this phenomenon has been reported in patients with much smaller central venous catheters (8F), particularly in cases of bilateral internal jugular vein cannualtion. 14 Based on these observations, we hypothesized that large dual lumen VV ECMO cannulas would increase the risk for ICH and in fact our study data confirmed this.…”

“…Further, a large number of patients develop cannula associated deep venous thrombosis during ECMO, which may contribute to intracranial venous hypertension. 5 Both smaller and large dual lumen VV ECMO cannulas are currently in use. At the present time, it remains unclear which cannula size is optimal for the "average" adult VV ECMO patient.…”

Extracorporeal Strategies in Acute Respiratory Distress Syndrome

“…An incidence of DVT after VV-ECMO with systematic screening as high as 85% has been described in patients on VV-ECMO. 46 The development of this complication does not seem to be associated with the level of anticoagulation achieved during ECMO but could be higher with larger dual-lumen cannulas. 47,48 The use of VV circuits allows clinicians to avoid the complications related to arterial cannulation, such as arterial bleeding, limb ischemia, and pseudoaneurysm formation.…”