Adult extracorporeal membrane oxygenation: an international survey of transfusion and anticoagulation techniques

• Published in: Vox sanguinis Vol. 112; no. 5; pp. 443 - 452
• Main Authors: Esper, S. A., Welsby, I. J., Subramaniam, K., John Wallisch, W., Levy, J. H., Waters, J. H., Triulzi, D. J., Hayanga, J. W. A., Schears, G. J.
• Format: Journal Article
• Language: English
• Published: England S. Karger AG 01.07.2017
• Subjects: Anticoagulants; Anticoagulants - pharmacology; anticoagulation; bleeding; Blood Coagulation; Blood Transfusion - methods; cardiopulmonary bypass; Cross-Sectional Studies; extracorporeal life support; Extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - methods; Health care; Health Care Surveys; Heart; Heart diseases; Hemostasis; Hemostatics; Heparin - pharmacology; Humans; Inflammation; Inflammatory response; Institutions; Morbidity; Multiple choice; Oxygenation; Patients; Respiratory failure; Respiratory therapy; Surgery; thrombosis; Transfusion; Whole Blood Coagulation Time; cardiopulmonary bypass; extracorporeal life support; extracorporeal membrane oxygenation; bleeding; thrombosis; anticoagulation
• ISSN: 0042-9007; 1423-0410; 1423-0410
• DOI: 10.1111/vox.12514

Background and objectives Extracorporeal membrane oxygenation (ECMO) is a method of life support for either isolated cardiac failure or respiratory failure, with or without cardiac failure. When used for hemodynamic support, the ECMO circuit presents a non‐endothelialized, artificial surface to blood inciting an inflammatory response which activates haemostatic pathways. Anticoagulation may complicate a pre‐existing coagulopathy and/or inadequate surgical hemostasis of varying severity. There is no standardized method to achieve and monitor anticoagulation or guide transfusion therapy during ECMO. We tested the hypothesis that institutions across the world conduct similar management of anticoagulation and transfusion during adult ECMO support. Methods This is a descriptive, self‐reporting cross‐sectional survey of anticoagulation and transfusion practice for patients age 18 or older on ECMO. This 38 multiple‐choice question survey was sent to 166 institutions, internationally, utilizing adult ECMO. About 32·4% (54) of institutions responded. Responses were anonymously collected. Descriptive analyses were calculated. Results Our findings indicate there appears to be a significant practice variation among institutions regarding anticoagulation and transfusion during adult ECMO support. Discussion The lack of standard practices among institutions may reflect a paucity of data regarding optimal anticoagulation and transfusion for patients requiring ECMO. Standardized protocols for anticoagulation and transfusion may help increase quality of care for and reduce morbidity, mortality and cost to patients and healthcare centres. Further study is required for standardized, high quality care.