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PedsCrit
ECMO Anticoagulation with Dr. Ali McMichael and Dr. Lisa Settle--Part 2
Oct 17, 2022
Dr. Ali McMichael and Dr. Lisa Settle discuss the challenges of interpreting lab test results in neonates on ECMO, the use of thromboelastography tags to assess anticoagulation, and managing anticoagulation in patients with elevated bilirubin and triglyceride levels. The podcast also explores patient selection for ECMO and alternative interventions for hemorrhaging.
25:05
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Quick takeaways
- The anti-factor tenae test is a useful measure of heparin effect in patients on ECMO, but its interpretation can be influenced by factors such as bilirubinemia, high triglycerides, and plasma free hemoglobin levels.
- Physical elastic assays like tag or rotem offer a comprehensive approach to evaluating clot formation, fibrolysis, platelet function, and overall clot strength in ECMO anticoagulation, although further research is needed to validate their effectiveness and overcome challenges related to availability and cost.
Deep dives
Understanding Lab Tests for Anticoagulation
The podcast episode discusses various lab tests used to monitor anticoagulation in patients on heparin. The anti-factor tenae test is highlighted as a measure of heparin effect, influenced by factors such as bilirubinemia, high triglycerides, and plasma free hemoglobin levels. The episode also explores the controversy around setting a goal range for activated partial thromboplastin time (APTT), with suggestions ranging from 60 to 80 for adults and one and a half to two and a half times baseline for neonates and infants. The use of activated clotting time (ACT) as a trend to monitor clot formation and the introduction of physical elastic assays like tag or rotem are discussed as potential advancements in anticoagulation monitoring.
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Discover
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