ECMO and Anticoagulation

[Annaiya, NP]

Hi all,

I'm looking for resources on managing a patient on ECMO. Also, a detailed explanation of circuit anticoagulation therapy and how to manage it would be great (this could be ECMO specific or CVVH would be fine too, just trying to understand anti coagulating a circuit). I have been trying to find information on this, but haven't found anything that's really what I'm looking for. Thanks!

[ghillbert, MSN, NP]

There is a lot of published data about this. What exactly do you not understand?

[Annaiya, NP]

I'm trying to understand the management better. Where I used to work they paid more attention to ACTs and where I am now follows the anti Xa's but still checks ACTs and PTTs. And then I'm not sure where the AT III comes in which is also checked. Is the circuit more likely to clot if one of those is too low? When the numbers are super high, I've seen the heparin turned off but the person running the ECMO pump seems to get really agitated when that suggested. I understand both sides but don't understand it well enough to feel qualified to make that decision. I found myself in that situation at work and wanted to try to learn more so next time I have a more educated opinion.

[Screen name]

I've seen quite a few pumps come down with DIC.

[Corey Narry, MSN, RN, NP]

I only deal with adult ECLS and we have institutional policy that has worked well in our setting.

There is literature on neonatal ECMO that have explored differences in aPTT, ACT, and antiXa values and its significance in this particular population: Evaluation of Heparin Assay for Coagulation Management in Newborns Undergoing ECMO

I haven't seen a similar study on adults.

Your best bet is to join the ELSO discussion board: Home - Extracorporeal Life Support Organization