Runtime and aPTT predict venous thrombosis and thromboembolism in patients on extracorporeal membrane oxygenation: a retrospective analysis

BACKGROUND: Even though bleeding and thromboembolic events are major complications of extracorporeal membrane oxygenation (ECMO), data on the incidence of venous thrombosis (VT) and thromboembolism (VTE) under ECMO are scarce. This study analyzes the incidence and predictors of VTE in patients treated with ECMO due to respiratory failure. METHODS: Retrospective analysis of patients treated on ECMO in our center from 04/2010 to 11/2015. Patients with thromboembolic events prior to admission were excluded. Diagnosis was made by imaging in survivors and postmortem examination in deceased patients. RESULTS: Out of 102 screened cases, 42 survivors and 21 autopsy cases [mean age 46.0 ± 14.4 years; 37 (58.7 %) males] fulfilling the above-mentioned criteria were included. Thirty-four patients (54.0 %) underwent ECMO therapy due to ARDS, and 29 patients (46.0 %) with chronic organ failure were bridged to lung transplantation. Despite systemic anticoagulation at a mean PTT of 50.6 ± 12.8 s, [VT/VTE 47.0 ± 12.3 s and no VT/VTE 53.63 ± 12.51 s (p = 0.037)], VT and/or VTE was observed in 29 cases (46.1 %). The rate of V. cava thrombosis was 15/29 (51.7 %). Diagnosis of pulmonary embolism prevailed in deceased patients [5/21 (23.8 %) vs. 2/42 (4.8 %) (p = 0.036)]. In a multivariable analysis, only aPTT and time on ECMO predicted VT/VTE. There was no difference in the incidence of clinically diagnosed VT in ECMO survivors and autopsy findings. CONCLUSIONS: Venous thrombosis and thromboembolism following ECMO therapy are frequent. Quality of anticoagulation and ECMO runtime predicted thromboembolic events

Mast Cells in the Laryngeal Mucosa of the Rat

Mucosal mast cells (MMCs) and connective tissue mast cells (CTMCs) in the epiglottic and subglottic regions in the rat larynx were characterized and quantified by immunohistochemistry and by light and electron microscopy, in control rats and rats injected intraperitoneally with dexamethasone and compound 48/80. Considerable regional differences were observed in the distribution of mast cells, especially in the epiglottis, where most cells were located on the laryngeal side. In the epithelium of the subglottic region the MMCs showed immunoreactivity for 5-hydroxytryptamine, in contrast to the epithelial MMCs in the epiglottis. In ultrathin sections, the subglottic MMCs contained larger but fewer granules compared with the epiglottic MMCs. After treatment with dexamethasone, the MMCs in the epithelium disappeared, while after treatment with compound 48/80 a large number of the CTMCs in the lamina propria became degranulated, though still present. This study shows that MMCs in the epiglottic and subglottic regions may be of two subtypes, differing in number and size of the granules as well as in chemical content