Regional anticoagulation with heparin of an extracorporeal CO2 removal circuit: a case report

• Main Authors: Jacopo Tramarin, Andrea Cortegiani, Cesare Gregoretti, Filippo Vitale, Cesira Palmeri, Pasquale Iozzo, Francesco Forfori, Antonino Giarratano
• Format: Article
• Language: English
• Published: BMC 2019-05-01
• Series: Journal of Medical Case Reports
• Subjects: Extracorporeal CO2 removal; Heparin regional anticoagulation; Continuous venovenous filtration
• Online Access: http://link.springer.com/article/10.1186/s13256-019-2051-6

Abstract Background Extracorporeal carbon dioxide removal is an increasingly used respiratory support technique. As is true of all extracorporeal techniques, extracorporeal carbon dioxide removal needs proper anticoagulation. We report a case of a patient at risk of bleeding complications who was treated with extracorporeal carbon dioxide removal and anticoagulated with a regional technique. Case presentation A 56-year-old Caucasian man with a history of chronic obstructive pulmonary disease exacerbation required extracorporeal carbon dioxide removal for severe hypercapnia and acidosis despite mechanical ventilation. The extracorporeal circuit was anticoagulated using a regional heparin technique to limit the patient’s risk of bleeding due to a low platelet count. The patient underwent 96 h of effective extracorporeal carbon dioxide removal without any adverse events. He was successfully weaned from extracorporeal carbon dioxide removal. During the treatment, no bleeding complications or unexpected circuit clotting was observed. Conclusions The use of regional heparin anticoagulation technique seems to be feasible and safe during extracorporeal carbon dioxide removal.