Fresh frozen plasma: A solution to heparin resistance during extracorporeal membrane oxygenation (ECMO)

Abstract

Objective: The management of Heparin resistance in patients undergoing ECMO is still uncertain. We sought to assess the efficacy and safety of Fresh frozen plasma to optimize the anticoagulation in these patients. Methods: We studied 42 adults undergoing VA-ECMO. Heparin infusion was increased incrementally to achieve target ACT in HG group and plasma administered in FFPG group in heparin resistance (HR) patients. Statistical comparison was performed between these two groups and results compared with non-heparin resistance (Non-HR) patients. Results: Overall 36% survived and 64% suffered bleeding complications. There was no difference in age (p = 0.118) or average ECMO duration (p = 0.393). The heparin requirement was significantly less in FFPG (p = 0.008) and average ACT difference of 159.2 (20.3) was highly significant (p < 0.001). Clinically the survival was higher in FFPG (50% vs 10%) without statistical difference (p = 0.07) probably due to small sample size. Twenty HR compared to 22 Non-HR patients. The survival rate (41% vs 30%) was not statistically significant (p = 0.340). However, more bleeding 80% vs 50% recorded in HR (p = 0.043) even though heparin doses between them was not different. Conclusions: The heparin requirement was high in patients treated with heparin alone. Fresh frozen plasma effectively increased ACT to therapeutic target in HR patients. There was no difference in the heparin dose, significantly higher bleeding complications were recorded in HR patients. Clinically, survival was better in Non-heparin resistance and plasma treated patients that was not found to be statistically significant. Keywords: Extracorporeal membrane oxygenation, Heparin resistance, Anticoagulation, Fresh frozen plasma, Bleeding