• A R Webb, M G Mythen, D Jacobson, and I J Mackie.
• Bloomsbury Institute of Intensive Care Medicine, Middlesex Hospital, London, UK.
• Intensive Care Med. 1995 Jan 1; 21 (1): 84-93.

ObjectivesTo review the methods and developments in maintaining extracorporeal circuits in critically ill patients.DesignThe review includes details of the pathophysiological processes of haemostasis and coagulation in critically ill patients, methods of maintaining blood flow in the extracorporeal circuit and methods of monitoring anticoagulation agents used.SettingInformation is relevant to the management of critically ill patients requiring extracorporeal renal and respiratory support and cardiopulmonary bypass.ConclusionsHeparin is the mainstay of anticoagulation for the extracorporeal circuit although the complex abnormalities of the coagulation system in critically ill patients are associated with a considerable risk of bleeding. Alternative therapeutic agents and physical strategies (prostacyclin, low molecular weight heparin, sodium citrate, regional anticoagulation, heparin bonding and attention to circuit design) may reduce the risk of bleeding but expense and difficulty in monitoring are disadvantages.

13 keywords...

hide…