A Question for ECMOlogists out there

med-rich · Mar 21, 2014

Hi there janfrn,

I'm new to this site and can find no way to PM or Email you,

Can you get in contact with me please as I may be able to help regarding this matter,

Kind regards,

med-rich

Pediatric Critical Care Columnist · Mar 21, 2014

You can't email me because of my privacy settings. You can't PM me because you haven't made 15 contributory posts yet. This is explained in the Terms of Service. If you haven't yet, I highly recommend giving them a look. There's a link at the bottom of every page.

Is what you wish to share with me something that you can't share with the group at large?

Advanced Practice Columnist / Guide · Mar 23, 2014

My experience is only with adult ECLS and I'm also not part of a Mechanical Circulatory Support Service at our hospital, rather, I'm an NP in an adult ICU service that also admits patients on ECMO (the management of the device is done by the RN's and the Mechanical Circulatory Support Service).

We only use centrifugal pumps now because they are smaller and more portable. Our hospital purchased multiple units of the Cardiohelp system and have used them during this season's flu pandemic on many patients. We've used other systems before including Centrimag.

We check ACT q 1 hour until stable then q 2 hours. ACT is a point of care testing, the equipment is in the unit. aPTT also gets checked based on Heparin infusion protocol. The specimen is sent to the lab and results come back based on lab turn around times. Goals are set based on individual risks of bleeding and existing concerns.

If you want more information on ECLS practice across various centers in particular, you can join the ELSO discussion board and I'm sure many experts from many centers will weigh in. The web address is Discussion Board.

Pediatric Critical Care Columnist · Mar 24, 2014

Thank you for your response, juan de la cruz. I've been a member of our ECLS team in the past and am aware of ELSO. I'm looking for info on practice related to ACTs because ours seem to be quite arbitrary without a good rationale for why we're setting our goals where they are. We use Centrimag pumps both for ECMO and as ventricular assists. For my own interest, I want to be able to understand how these numbers, which seem to be plucked out of the air, are actually arrived at. We have a thrombosis team that guides practice but it still seems that there's no good evidence for doing what we do. We have as many - or more - issues around anticoagulation now than we've ever had.