Free ECMO Anticoagulation & Hemodynamics in ECMO Questions and Answers

Question 1

What is the primary purpose of anticoagulation during ECMO therapy?

Accepted Answer

To stop clot formation

Answer

The foreign surfaces of the ECMO circuit activate the coagulation cascade, making clot formation (thrombosis) a significant risk. Anticoagulation, typically with heparin, is administered to prevent these clots from forming within the circuit, which could lead to circuit failure, or from embolizing to the patient, causing severe complications like stroke or organ damage. This is crucial for circuit patency and patient safety.

Question 2

Which lab test is most commonly used to monitor heparin therapy in ECMO?

Accepted Answer

aPTT

Answer

The activated Partial Thromboplastin Time (aPTT) is a common laboratory test used to monitor the effectiveness of unfractionated heparin therapy, which is frequently used for anticoagulation during ECMO. It measures the time it takes for blood to clot via the intrinsic and common pathways, providing an indication of the patient's anticoagulation status and guiding heparin dosing.

Question 3

Which hemodynamic parameter indicates the afterload the heart must overcome?

Accepted Answer

SVR

Answer

Systemic Vascular Resistance (SVR) represents the total resistance to blood flow in the systemic circulation, which the left ventricle must overcome to eject blood. It is a key determinant of afterload, the pressure the heart works against. Monitoring SVR helps assess the patient's hemodynamic status and guides the use of vasoactive medications to optimize blood pressure and organ perfusion.

Question 4

What is the target ACT range for most ECMO protocols using heparin?

Accepted Answer

180–220 seconds

Answer

The target Activated Clotting Time (ACT) range for most ECMO protocols using unfractionated heparin is typically between 180 and 220 seconds. This range aims to provide adequate anticoagulation to prevent circuit thrombosis while minimizing the risk of bleeding complications. Specific targets can vary slightly based on institutional protocols, patient factors, and the type of ECMO support.

Question 5

Which complication can result from excessive anticoagulation during ECMO?

Accepted Answer

Bleeding

Answer

While anticoagulation is essential to prevent clots in the ECMO circuit, excessive anticoagulation significantly increases the risk of bleeding. ECMO patients are already vulnerable to bleeding due to their critical illness, invasive procedures, and platelet dysfunction. Over-anticoagulation can lead to severe hemorrhage, which is a major cause of morbidity and mortality and requires careful management.

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Free ECMO Anticoagulation & Hemodynamics in ECMO Questions and Answers