title: Variability in anticoagulation management of patients on extracorporeal membrane oxygenation: an international survey.
abstract: OBJECTIVE
  The objective of this study was to determine current practices of anticoagulation in patients on extracorporeal membrane oxygenation.
  
  
  METHODS
  Internet-based cross-sectional survey distributed between November 2010 and May 2011.
  
  
  METHODS
  Extracorporeal Life Support Organization-registered extracorporeal membrane oxygenation centers internationally.
  
  
  METHODS
  : Extracorporeal membrane oxy genation medical directors and coordinators.
  
  
  METHODS
  None.
  
  
  RESULTS
  There were 121 responses from extracorporeal membrane oxy genation medical directors and coordinators at 187 Extracorporeal Life Support Organization centers with access to the survey. Eighty-four of 117 (72%) respondents reported having a written institutional extracorporeal membrane oxy genation protocol for both anticoagulation and blood product management at their institutions. Sixty-nine of 117 (59%) respondents reported use of tip-to-tip or partially heparin-bonded circuits. Unfractionated heparin was used at all centers; only 8% of respondents indicated use of alternative anticoagulation medications in the six months prior to the survey. The preferred method of anticoagulation monitoring was the serial measurement of activated clotting time, as reported by 97% of respondents. In this survey, 82% of respondents reported antithrombin III testing, 65% reported anti-factor Xa testing, and 43% reported use of thromboelastography during extracorporeal membrane oxy genation. Goal ranges for these three tests and interventions triggered by out-of-range values were found to be variable.
  
  
  CONCLUSIONS
  Extracorporeal membrane oxy genation anticoagulation management policies vary widely by center. The majority of extracorporeal membrane oxy genation programs employ activated clotting time as the preferred anticoagulation monitoring tool. The coagulation system is also monitored using more specific markers such as antithrombin III, anti-factor Xa, and thromboelastography by a large number of centers. Future research is needed to elucidate optimal anticoagulation management and improve outcomes.
authors.affiliation: Department of Anesthesiology and Critical Care, Johns Hopkins University, Baltimore, MD, USA. mbembea1@jhmi.edu
authors.forename: Melania M
authors.initials: MM
authors.lastname: Bembea
authors.forename: Gail
authors.initials: G
authors.lastname: Annich
authors.forename: Peter
authors.initials: P
authors.lastname: Rycus
authors.forename: Gary
authors.initials: G
authors.lastname: Oldenburg
authors.forename: Ivor
authors.initials: I
authors.lastname: Berkowitz
authors.forename: Peter
authors.initials: P
authors.lastname: Pronovost
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D000990:Antithrombin III / Q000378:metabolism; D003430:Cross-Sectional Studies; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006493:Heparin / Q000008:administration & dosage; D006757:Hospital Units; D006801:Humans; D057766:Policy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D013916:Thrombelastography
chemical_list: D000925:Anticoagulants; D000990:Antithrombin III; D006493:Heparin