• Gennaro Martucci, Marco Giani, Matthieu Schmidt, Kenichi Tanaka, Ali Tabatabai, Fabio Tuzzolino, Cara Agerstrand, Jordi Riera, Raj Ramanan, Giacomo Grasselli, Ait HssainAliAHamad Medical Corporation, Doha, Qatar., Whitney D Gannon, Sara Buabbas, Vojka Gorjup, Brian Trethowan, Monica Rizzo, Vito Fanelli, Kyeongman Jeon, Gennaro De Pascale, Alain Combes, Marco V Ranieri, Thibault Duburcq, Giuseppe Foti, Juan I Chico, Martin Balik, Lars Mikael Broman, Peter Schellongowski, Hergen Buscher, Roberto Lorusso, Daniel Brodie, Antonio Arcadipane, and International ECMO Network (ECMONet).
• Department of Anesthesia and Intensive Care and.
• Am. J. Respir. Crit. Care Med. 2024 Feb 15; 209 (4): 417426417-426.

AbstractRationale: Definitive guidelines for anticoagulation management during veno-venous extracorporeal membrane oxygenation (VV ECMO) are lacking, whereas bleeding complications continue to pose major challenges. Objectives: To describe anticoagulation modalities and bleeding events in adults receiving VV ECMO. Methods: This was an international prospective observational study in 41 centers, from December 2018 to February 2021. Anticoagulation was recorded daily in terms of type, dosage, and monitoring strategy. Bleeding events were reported according to site, severity, and impact on mortality. Measurements and Main Results: The study cohort included 652 patients, and 8,471 days on ECMO were analyzed. Unfractionated heparin was the initial anticoagulant in 77% of patients, and the most frequently used anticoagulant during the ECMO course (6,221 d; 73%). Activated partial thromboplastin time (aPTT) was the most common test for monitoring coagulation (86% of days): the median value was 52 seconds (interquartile range, 39 to 61 s) but dropped by 5.3 seconds after the first bleeding event (95% confidence interval, -7.4 to -3.2; P < 0.01). Bleeding occurred on 1,202 days (16.5%). Overall, 342 patients (52.5%) experienced at least one bleeding event (one episode every 215 h on ECMO), of which 10 (1.6%) were fatal. In a multiple penalized Cox proportional hazard model, higher aPTT was a potentially modifiable risk factor for the first episode of bleeding (for 20-s increase; hazard ratio, 1.07). Conclusions: Anticoagulation during VV ECMO was a dynamic process, with frequent stopping in cases of bleeding and restart according to the clinical picture. Future studies might explore lower aPTT targets to reduce the risk of bleeding.

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