• Hergen Buscher, Alexander Vukomanovic, Mark Benzimra, Kazuhiro Okada, and Priya Nair.
• Department of Intensive Care, St. Vincent's Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia. Electronic address: Hergen.buscher@svha.org.au.
• J. Cardiothorac. Vasc. Anesth. 2017 Jun 1; 31 (3): 869-875.

ObjectiveTo describe blood management and anticoagulation practice for cardiac and respiratory extracorporeal membrane oxygenation (ECMO) with consideration of major surgery at the time of its initiation.DesignA single-center retrospective review over 18 months of blood product usage and anticoagulation in patients treated with veno-venous (VV) ECMO versus veno-arterial (VA) ECMO and after major surgery (Sx) versus no surgery (Nsx).SettingTertiary metropolitan hospital and state ECMO referral and heart and lung transplantation center.ParticipantsThe study comprised 42 patients representing 48 consecutive ECMO runs (16 VV, 32 VA, 26 Sx, 22 Nsx).InterventionsNone.Measurements And Main ResultsThirty-three percent of the total run time of 362 days was with no continuous infusion of heparin. The mean (standard deviation) daily dose of heparin was lower for Sx versus Nsx patients (11,397 [9,297] v 17,324 [10,387] U, p = 0.047). Sx patients also received more fresh frozen plasma (1.1 [1.93] v 0.2 [0.59] U per day, p = 0.049) and platelets (0.5 [0.51] v 0.1 [0.25] U per day, p = 0.003). VV patients received fewer packed red cells (0.7 [0.45] v 2.0 [2.04] U per day, p = 0.016) and platelets (0.1 [0.18] v 0.4 [0.49] U per day, p = 0.008) compared with VA patients. Survival to hospital discharge was 69%.ConclusionsHeparin doses were low, with frequent interruption of anticoagulation. This was more pronounced in patients with a high bleeding risk recovering from major surgery. The overall usage of blood products was low in VV and Nsx patients, with an overall excellent survival rate.Copyright © 2017 Elsevier Inc. All rights reserved.

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