Soluble fibrin is a useful marker for predicting extracorporeal membrane oxygenation circuit exchange because of circuit clots

Kota Hoshino, Kentaro Muranishi, Yasumasa Kawano, Hiroki Hatomoto, Shintaro Yamasaki, Yoshihiko Nakamura, Hiroyasu Ishikura

A circuit clot is one of the most frequent complications during extracorporeal membrane oxygenation (ECMO) support. We identify coagulation/fibrinolysis markers for predicting ECMO circuit exchange because of circuit clots during ECMO support. Ten patients with acute pulmonary failure who underwent veno-venous ECMO were enrolled between January 2014 and December 2016. ECMO support lasted 106 days. The 6 days on which the ECMO circuits were exchanged were considered as circuit clot (+) group, while the remaining 100 days were considered as circuit clot (-) group. The predictors of ECMO circuit exchange because of circuit clots were identified. The mean duration of ECMO support was 10 ± 13 days, and the mean number of ECMO circuit exchange was 0.6 ± 1.1 times per patient. Thrombin-antithrombin complex (TAT) and soluble fibrin (SF) were higher in the circuit clot (+) group than in the circuit clot (-) group (both P < 0.01). According to a multivariate analysis, SF was the only independent predictor of ECMO circuit exchange (P < 0.01). The odds ratio (confidence intervals) for SF (10 µg/ml) was 1.20 (1.06-1.36). The area under the curve and optimal cut-off value were 0.95 and 101 ng/ml for SF (sensitivity, 100%; specificity, 89%). SF may be useful in predicting ECMO circuit exchange because of circuit clots.