Hematologic Observations Made in Patients With Acute Respiratory Distress Syndrome in the Cooperative ECMO Project

Publisher Website
Google Scholar
Abstract
In a recently completed 3 yr multicenter trial, 90 individuals with adult acute respiratory distress syndrome (ARDS) were randomly allocated to conventional therapy with or without long-term extracorporeal membrane oxygenation (ECMO). ARDS was associated with frequent major bleeding and thrombotic episodes; the bleeding correlated best with the degree of thrombocytopenia and was enhanced by the machine. Heparin''s therapeutic efficacy and its ability to increase bleeding were not proven. ARDS was associated with a complex coagulatin disturbance. Besides thrombocytopenia, there were lowered circulating levels of factors VII and XII which possibly were related to pulmonary endothelium changes. ECMO as associated with relative leukopenia and a marked shift to immature circulating leukocytes. Further studies of ARDS patients are needed to better define the clinical imporance of thrombosis and bleeding in the lung, the role for heparin in treatment and the meaning of coagulation factor reductions in defining this disease''s course, prognosis and therapy response.