ECMO Anticoagulation and Hemostasis 2

Question 1

Which coagulation factor is most significantly consumed during ECMO due to continuous contact with the circuit surface?

Accepted Answer

Fibrinogen

Answer

Fibrinogen is rapidly consumed during ECMO due to adsorption onto circuit surfaces and ongoing fibrinolysis, making it a critical monitoring parameter.

Question 2

A patient on ECMO has an ACT of 280 seconds and develops a new intracranial hemorrhage. What is the most appropriate immediate anticoagulation management?

Accepted Answer

Discontinue heparin entirely and monitor closely

Answer

Life-threatening intracranial hemorrhage on ECMO typically requires complete heparin discontinuation, accepting the risk of circuit thrombosis to prevent further bleeding.

Question 3

What is the primary mechanism by which bivalirudin anticoagulates ECMO patients?

Accepted Answer

Directly and reversibly inhibiting free and clot-bound thrombin

Answer

Bivalirudin is a direct thrombin inhibitor that binds both free and fibrin-bound thrombin directly without requiring antithrombin as a cofactor.

Question 4

During ECMO, which laboratory test specifically assesses fibrinolytic activity and can detect hyperfibrinolysis?

Accepted Answer

Thromboelastography (TEG) lysis index

Answer

TEG/ROTEM provides a lysis index (LY30 or ML) that quantifies clot lysis over time, directly detecting hyperfibrinolysis in ECMO patients.

Question 5

A neonate on VA-ECMO has a platelet count of 65,000/μL. What is the standard transfusion threshold for neonates on ECMO?

Accepted Answer

100,000/μL

Answer

Most ECMO centers maintain platelet counts above 100,000/μL in neonates due to their higher hemorrhagic risk, particularly for intracranial hemorrhage.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO Anticoagulation and Hemostasis 2