From the Guidelines
An ECMO unit scut sheet should prioritize anticoagulation management, including heparin administration and monitoring of ACT levels between 180 and 220 seconds, as recommended by the American Heart Association 1. When creating an ECMO unit scut sheet, it is essential to include the following key components:
- Patient demographics: name, age, diagnosis, ECMO indication, and days on ECMO
- ECMO circuit details: type (VA or VV), cannulation sites, flow rates, sweep gas settings, and membrane oxygenator function
- Vital signs: temperature, heart rate, blood pressure, oxygen saturation
- Ventilator settings: mode, FiO2, PEEP, tidal volume
- Hemodynamic parameters: cardiac output, SVR, and vasopressor/inotrope doses
- Anticoagulation data: heparin infusion rate, target ACT/PTT ranges, and most recent values, with a focus on maintaining ACT levels between 180 and 220 seconds as recommended by the American Heart Association 1
- Laboratory values: daily ABGs, coagulation studies, CBC, electrolytes, and organ function tests, including anti-FXa levels, hemoglobin, hematocrit, PT, PTT, and AT III, which are essential for managing anticoagulation and correcting coagulation defects 1 The scut sheet should be updated at least every 12 hours or with any significant clinical changes to ensure accurate documentation and monitoring of ECMO parameters, and to facilitate efficient handoffs between medical teams. It is also crucial to consider the administration of 100 U/kg heparin before ECMO cannulation and the use of additional hematologic laboratory data to manage anticoagulation, as outlined in the American Heart Association's recommendations 1.
From the Research
ECMO Unit Scut Sheet
- The Extracorporeal Membrane Oxygenation (ECMO) unit requires closely monitored anticoagulation therapy to prevent thrombosis and bleeding complications 2, 3.
- Anticoagulation monitoring strategies for ECMO patients include activated clotting time (ACT), activated partial thromboplastin time (aPTT), and anti-factor Xa (Anti-Xa) assays 2, 4.
- Studies have shown that Anti-Xa and aPTT are more suitable for anticoagulation monitoring in ECMO patients than ACT, as they correlate better with heparin dose and provide more stable anticoagulation 2, 4.
- Combined monitoring strategies, such as using both Anti-Xa and aPTT, may have advantages in reducing mortality and blood product transfusion in ECMO patients 4.
- The choice of anticoagulation monitoring strategy may depend on the individual patient's needs and the specific ECMO protocol being used 3, 4.
- There is limited evidence on the use of thromboelastography in ECMO patients, and more research is needed to determine its effectiveness in this population 4.
- One study found no correlation between anti-Xa and ACT in ECMO patients, and kappa analysis showed no agreement between the respective target ranges of ACT and anti-Xa 2.
- Unfractionated heparin is the most commonly used anticoagulation in ECMO centers, but it requires close monitoring to prevent complications 3.
- Note that the study from 1977 5 is not relevant to the topic of ECMO unit scut sheet.