Skip to main content

Monitoring anticoagulation during extracorporeal membrane oxygenation in patients with acute respiratory failure

Introduction

aPTT is a common tool for anticoagulation monitor ing during extracorporeal membrane oxygenation (ECMO). Thromboelasto graphy (TEG) is another available option in this setting.

Methods

A prospective observational study on 12 consecutive patients during venovenous ECMO. Anticoagulation was provided with unfractioned heparin titrated to an aPTT ratio target of 1.5 to 2. Kaolin-activated TEG (K-TEG) was contemporarily measured but did not guide heparin infusion. Baseline K-TEG reaction time (R) >20 minutes is accepted for anticoagulation but when it exceeds 90 minutes anticoagulation may be too great [1].

Results

Mean ECMO duration was 9 ± 4 days. A total of 152 K-TEGs were collected. Comparison between aPTT and K-TEG R is reported in Table 1. Four patients (33%) had hemorrhagic complications. Neither aPTT nor K-TEG R were significantly different in patients with hemorrhagic events compared with patients without hemorrhagic events but the latter received a significantly lower total heparin dose (P = 0.0097).

Table 1 Comparison between aPTT and K-TEG R

Conclusion

Anticoagulation was excessive in more than one-half of the samples according to TEG monitoring, while negligible based on aPTT.

References

  1. 1.

    Oliver WC: Semin Cardiothorac Vasc Anesth. 2009, 13: 154-175. 10.1177/1089253209347384

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to M Panigada.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Panigada, M., Mietto, C., Pagan, F. et al. Monitoring anticoagulation during extracorporeal membrane oxygenation in patients with acute respiratory failure. Crit Care 17, P126 (2013). https://doi.org/10.1186/cc12064

Download citation

Keywords

  • Heparin
  • Respiratory Failure
  • Acute Respiratory Failure
  • Prospective Observational Study
  • Unfractioned Heparin