title: Blood and Anticoagulation Management in Extracorporeal Membrane Oxygenation for Surgical and Nonsurgical Patients: A Single-Center Retrospective Review.
abstract: 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.
  
  
  METHODS
  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).
  
  
  METHODS
  Tertiary metropolitan hospital and state ECMO referral and heart and lung transplantation center.
  
  
  METHODS
  The study comprised 42 patients representing 48 consecutive ECMO runs (16 VV, 32 VA, 26 Sx, 22 Nsx).
  
  
  METHODS
  None.
  
  
  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.
authors.affiliation: Department of Intensive Care, St. Vincent's Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia. Electronic address: Hergen.buscher@svha.org.au.
authors.forename: Hergen
authors.initials: H
authors.lastname: Buscher
authors.affiliation: Department of Intensive Care, St. Vincent's Hospital, Sydney, Australia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Vukomanovic
authors.affiliation: Department of Lung Transplantation, St. Vincent's Hospital, Sydney, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Benzimra
authors.affiliation: Department of Intensive Care, St. Vincent's Hospital, Sydney, Australia.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Okada
authors.affiliation: Department of Intensive Care, St. Vincent's Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia.
authors.forename: Priya
authors.initials: P
authors.lastname: Nair
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D001777:Blood Coagulation / Q000187:drug effects* / Q000502:physiology; D001803:Blood Transfusion / Q000639:trends*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000639:trends*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: anticoagulation; blood management; extracorporeal life support; extracorporeal membrane oxygenation; hemorrhage; transfusion