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Evaluation of a heparin monitoring protocol for extracorporeal membrane oxygenation and review of the literature

	author = {Ellen Colman and Ellen B. Yin and Greg Laine and Subhasis Chatterjee and Siavosh Saatee and J. Patrick Herlihy and Meredith A. Reyes and Arthur W. Bracey},
	title = {Evaluation of a heparin monitoring protocol for extracorporeal  membrane oxygenation and review of the literature},
	journal = {Journal of Thoracic Disease},
	volume = {11},
	number = {8},
	year = {2019},
	keywords = {},
	abstract = {Background: Bleeding complications are common with extracorporeal membrane oxygenation (ECMO). We investigated whether a heparin monitoring protocol using activated partial thromboplastin time (aPTT) and thromboelastography (TEG) affected clinical outcomes.
Methods: This retrospective chart review stratified cohorts by study interval: pre-protocol (January 2016–March 2017) or post-protocol (March 2017–December 2017). The protocol defined therapeutic anticoagulation as aPTT of 60–80 seconds and a TEG reaction (TEG-R) time of 2–4× baseline; pre-protocol management used aPTT alone. The primary endpoints were the rates of bleeding and thrombotic events (clinical/device thrombosis) as defined by Extracorporeal Life Support Organization (ELSO) guidelines. Secondary endpoints included time in therapeutic aPTT range, rate of physician compliance with the protocol, time to heparin initiation, intensive care unit length of stay, mortality, and antithrombin III (ATIII) supplementation.
Results: The pre-protocol (n=72) and post-protocol (n=51) groups (age 60±12 years; 80% on venoarterial ECMO; average ECMO duration of 6 days) showed no difference in baseline characteristics. Major bleeding events occurred in 69% of pre-protocol patients, versus 67% of post-protocol patients (P=0.85). The post-protocol group had fewer retroperitoneal bleeds (P=0.01) and had a non-significantly lower rate of pulmonary or central nervous system (CNS) bleeding (P=0.07). Thrombotic events occurred in 21% of the pre-protocol group, versus 28% of the post-protocol group (P=0.39). Mortality during ECMO support was significantly lower in the post-protocol group (56.9% vs. 33.3%, P=0.01). The thrombosis rate was higher in patients who received ATIII than in those who did not (48.2% vs. 15.9%, P},
	issn = {2077-6624},	url = {}