Variance in management of extracorporeal membrane oxygenation-associated fibrin sheaths at a single institution

Alexandra Tedesco; Monica Majumdar; Jamel P Ortoleva; Christine Nayar; Masashi Kawabori; Payam Salehi; Ali Irshad

doi:10.1016/j.jvscit.2023.101121

Variance in management of extracorporeal membrane oxygenation-associated fibrin sheaths at a single institution

J Vasc Surg Cases Innov Tech. 2023 Feb 10;9(2):101121. doi: 10.1016/j.jvscit.2023.101121. eCollection 2023 Jun.

Authors

Alexandra Tedesco¹, Monica Majumdar¹, Jamel P Ortoleva², Christine Nayar³, Masashi Kawabori⁴, Payam Salehi⁵, Ali Irshad⁶

Affiliations

¹ Department of General Surgery, Tufts Medical Center, Boston, MA.
² Department of Anesthesia, Tufts Medical Center, Boston, MA.
³ Department of Pulmonary, Critical Care, and Sleep Medicine, Jefferson Abington Hospital, Abington, PA.
⁴ Department of Cardiothoracic Surgery, Tufts Medical Center, Boston, MA.
⁵ Department of Vascular Surgery, Tufts Medical Center, Boston, MA.
⁶ Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, TN.

Abstract

Objective: Extracorporeal membrane oxygenation (ECMO) support for patients with cardiac or respiratory failure has been increasingly used by advanced critical care practitioners. The thromboembolic complications of ECMO have been extensively discussed and researched; however, research and discussion on the development, risks, and management of cannulae-associated fibrin sheaths are lacking.

Methods: Institutional review board approval was not required. We have presented three cases detailing the identification and individualized management of ECMO-associated fibrin sheaths at our institution. The three patients provided written informed consent for the report of their case details and imaging studies.

Results: Of our three patients with ECMO-associated fibrin sheaths, two were managed successfully with anticoagulation alone. One could not receive anticoagulation therapy and underwent inferior vena cava filter placement.

Conclusions: Fibrin sheath formation around indwelling ECMO cannulae is an unresearched complication of ECMO cannulation. We would recommend an individualized approach to the management of these fibrin sheaths and have provided three examples of successful management.

Keywords: COVID-19; ECMO; Fibrin sheath; Thrombectomy; Thromboembolic complications.