Analysis of Heparin Protocols and Associated Hemorrhage in Patients on Extracorporeal Membrane Oxygenation Philip Nettle, Matthew Rubertus Emory University Healthcare - Atlanta, GA
Background/Purpose: Extracorporeal membrane oxygenation (ECMO) is used to temporarily support cardiac and/or respiratory function in patients with failure of those respective organs until the native organ(s) recover or other definitive therapy is implemented. The incidence of hemorrhage and thrombosis ranges from 10-30% and 8-53% respectively and are two principle causes of morbidity. Therapeutic anticoagulation, most commonly with unfractionated heparin (UFH), is necessary to prevent life-threatening thrombosis but it also increases the risk of excessive bleeding. Guidelines currently do not recommend a strategy to monitor and adjust doses of UFH. The activated clotting time (ACT) is utilized to monitor anticoagulation during ECMO at Emory University Hospital (EUH). The UFH titration protocol at EUH uniquely has two ACT goal ranges (high _x0013_ 180-220 seconds and low _x0013_ 140-180 seconds) which providers can select between based on multiple clinical factors. The aim of this study is to investigate the outcomes associated with the unique heparin protocol utilized at EUH.
Methodology: IRB-approved, retrospective chart review of patients who underwent vevo-venous or veno-arterial ECMO and had a heparin infusion greater than 24 hours at EUH between September 1, 2014 and September 1, 2017. Patients with a diagnosis of heparin-induced thrombocytopenia or the administration of an anticoagulant other than heparin greater than 48 hours will be excluded. The primary analysis is to evaluate incidence of major bleeding. The secondary analysis is to evaluate incidence of thrombotic complications, time within ACT goal range, mortality during ECMO cannulation and before hospital discharge. Demographic data to determine the type of bleed, heparin dose, ECMO configuration, indication for ECMO, ACT levels and ACT goal range will be collected.
Presentation Objective: To evaluate incidence of major bleeding in patients initiated on UFH while on ECMO
Self-Assessment: What are the benefits of an ECMO anticoagulation protocol with two goal levels of anticoagulation?
