EDECMO Podcast 55 – Anticoagulation of the ECMO Patient with Troy Seelhammer
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Jun 4, 2019 In a deep dive into anticoagulation management, Troy Seelhammer, an intensivist and co-director of the ECMO program at Mayo Clinic, shares his expertise. He challenges traditional views on the use of heparin, discussing when to be aggressive or conservative with anticoagulants. Conversations about the evolution of heparin-coated cannulas and the potential of bivalirudin add depth. Troy emphasizes the necessity of tailored anticoagulation strategies to enhance patient outcomes while minimizing complications during ECMO therapy.
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ECMO Coagulation Challenges
- ECMO circuits activate blood coagulation due to contact with foreign materials, requiring anticoagulation to prevent clotting.
- Modern biocompatible coatings reduce but do not eliminate the need for systemic anticoagulation over prolonged ECMO runs.
Timing & Flow Affect Clotting
- Early ECMO anticoagulation requires more intensity due to uncoated surfaces and fresh blood contact.
- High circuit flow rates reduce clot risk, enabling some prolonged anticoagulation-free ECMO periods.
Heparin Bolus at ECMO Start
- Give a heparin bolus of 30 to 70 IU/kg at ECMO initiation without waiting for labs.
- Start systemic anticoagulation after ECMO is running and local hemostasis is stable.