From the Guidelines
The normal strategy for an Extracorporeal Membrane Oxygenation (ECMO) circuit involves anticoagulation with heparin, with a loading dose of 100 U/kg before ECMO cannulation and a continuous infusion to maintain the activated clotting time (ACT) between 180 and 220 seconds, as recommended by the American Heart Association 1. The ECMO circuit is a complex life support system that requires careful management to minimize complications. Key components of ECMO management include:
- Anticoagulation with unfractionated heparin to prevent thrombosis, with monitoring of ACT, anti-FXa levels, hemoglobin, hematocrit, PT, PTT, and AT III levels at least daily 1
- Use of a qualified extracorporeal technologist to assist with ECMO management (Class I; Level of Evidence C) 1
- Surgical control of bleeding in patients with ongoing bleeding on ECMO (Class I; Level of Evidence C) 1
- Correction of coagulation defects, including AT III deficiency, with transfusion of fresh-frozen plasma or AT III supplementation (Class I; Level of Evidence C) 1 The use of heparin-bonded circuits with minimal heparinization may be considered as a strategy to decrease the risk of bleeding in high-risk patients (Class IIb; Level of Evidence C) 1. Additionally, the addition of the lysine analog EACA may be considered for patients with ongoing bleeding despite efforts at surgical hemostasis and correction of coagulation deficiencies (Class IIb; Level of Evidence C) 1. Overall, the goal of ECMO management is to provide temporary support for critically ill patients while minimizing complications and promoting recovery.
From the Research
Normal Strategy for ECMO Circuit
The normal strategy for an Extracorporeal Membrane Oxygenation (ECMO) circuit involves a multidisciplinary approach, including:
- A trained team consisting of physicians, perfusionists, nurses, and respiratory therapists 2
- Systemic anticoagulation with unfractionated heparin (UFH) to maintain circuit patency 3, 4
- Monitoring of anticoagulation using tools such as activated clotting time (ACT), activated partial thromboplastin time (aPTT), and anti-Xa activity 3, 4
- Careful fluid balance and daily echocardiographic transesophageal monitoring 5
- A low dose of adrenaline and vasoconstrictors, as well as the use of intra-aortic balloon pump (IABP) in some cases 5
Key Considerations
- The strategy for ECMO circuit management may vary depending on the specific patient population and the type of ECMO support being used (e.g. veno-venous or veno-arterial) 5, 6
- A multidisciplinary team approach is crucial for maximizing weaning and survival rates in patients receiving ECMO support 5, 6
- The use of ECMO support requires careful consideration of the potential risks and benefits, as well as close monitoring for complications such as bleeding and thrombosis 3, 4