Blood and Anticoagulation Management in Extracorporeal Membrane Oxygenation for Surgical and Nonsurgical Patients: A Single-Center Retrospective Review

Objective: To describe blood management and anticoagulation practice for cardiac and respiratory extracorporeal membrane oxygenation (ECMO) with consideration of major surgery at the time of its initiation. Design: A single-center retrospective review over 18 months of blood product usage and anticoagulation in patients treated with veno-venous (VV) ECMO versus veno-arterial (VA) ECMO and after major surgery (Sx) versus no surgery (Nsx). Setting: Tertiary metropolitan hospital and state ECMO referral and heart and lung transplantation center. Participants: The study comprised 42 patients representing 48 consecutive ECMO runs (16 VV, 32 VA, 26 Sx, 22 Nsx). Interventions: None. Measurements and Main Results: Thirty-three percent of the total run time of 362 days was with no continuous infusion of heparin. The mean (standard deviation) daily dose of heparin was lower for Sx versus Nsx patients (11,397 [9,297] v 17,324 [10,387] U, p = 0.047). Sx patients also received more fresh frozen plasma (1.1 [1.93] v 0.2 [0.59] U per day, p = 0.049) and platelets (0.5 [0.51] v 0.1 [0.25] U per day, p = 0.003). VV patients received fewer packed red cells (0.7 [0.45] v 2.0 [2.04] U per day, p = 0.016) and platelets (0.1 [0.18] v 0.4 [0.49] U per day, p = 0.008) compared with VA patients. Survival to hospital discharge was 69%. Conclusions: Heparin doses were low, with frequent interruption of anticoagulation. This was more pronounced in patients with a high bleeding risk recovering from major surgery. The overall usage of blood products was low in VV and Nsx patients, with an overall excellent survival rate. (c) 2017 Elsevier Inc. All rights reserved.