Anticoagulation
Bleeding
Bleeding is a common and severe complication of ECMO support. Initial management should involve:
- Cease anticoagulation
Resume when bleeding has ceased for 12-24 hours - Replace clotting factors
- Fibrinogen >1.5g/dL
- Platelets >80
- INR <1.3
For bleeding refractory to the above therapies, consider:
Avoid protamine in patients with heparin-bonded circuits due to risk of circuit thrombosis.
- Fibrinolytic
- Factor VIIa
- Interventional radiology
- Surgical