Abstract
For the past four decades, extracorporeal life support (ECLS) has been used to treat
critically ill adult and pediatric patients with cardiac and/or respiratory failure
unresponsive to medical management, and there are increasing numbers of centers performing
ECLS for numerous indications worldwide. Despite the progress with advancing technology,
hemorrhagic and thrombotic complications occur frequently and are associated with
worse outcomes, but the exact cause is often elusive or multifactorial. As a result
of the interaction between blood and a nonendothelialized circuit, there is activation
of coagulation, fibrinolysis, as well as an increased inflammatory response; thus,
anticoagulation of the patient and circuit is necessary. While unfractionated heparin
(UFH) remains the mainstay anticoagulant used during ECLS, there is a paucity of published
data to develop a universal anticoagulation guideline and centers are forced to create
individualized protocols to guide anticoagulation management, frequently while lacking
expertise. From an international survey, centers often use a combination of tests
to guide management, which in turn can lead to discordant results and confused management.
Studies are urgently needed to investigate optimization of current anticoagulation
strategies with UFH, as well as use of alternative anticoagulants and nonthrombogenic
biomaterials.
Keywords
extracorporeal life support - extracorporeal membrane oxygenation - anticoagulation
- heparin monitoring
