ECMO Complications: Bleeding, thrombosis, hemolysis, and neurologic complications (Akram Zaaqoq)
ECMO-Related Medical Discussions
Inflammatory Response and Coagulation:
Akram compared ECMO to cardiopulmonary bypass, noting ECMO’s distinct inflammatory and coagulation challenges. He recommended correcting coagulopathy and administering heparin during cannulation.
Anticoagulation Strategies:
He outlined the use of heparin (20–50 units/kg/hr) and alternative agents like bivalirudin and argatroban. He emphasized individualized monitoring due to factors like antithrombin 3 deficiency and reviewed methods including ACT, APTT, and ROTEM.
Strategy Review and Innovations:
He highlighted the challenges of balancing clotting and bleeding, discussed the role of plasma exchange and heparin-coated circuits, and acknowledged the absence of reversal agents for some anticoagulants.
Management in VV ECMO:
Akram noted that anticoagulation might be safely omitted in VV ECMO under close monitoring. He described a bleeding management algorithm involving cessation of anticoagulation, transfusions, and potential use of antifibrinolytics.
Neurological Complications in ECMO
Akram addressed the high mortality linked to strokes in ECMO patients. He stressed modifiable risk factors (e.g. blood pressure, CO₂, pH), early monitoring, and guideline-driven management