Hemostatic Management of Extracorporeal Circuits including Cardiopulmonary Bypass and Extracorporeal Membrane Oxygenation

Zhe Amy Fang, Amir Hassan Navaei, Lisa Hensch, Shiu Ki Rocky Hui, Jun Teruya*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Cardiopulmonary bypass and extracorporeal membrane oxygenation (ECMO) cause hemostatic derangements that can predispose patients to both bleeding and thrombotic complications. Often, patients present for urgent surgery while taking medications including antiplatelet agents, vitamin K antagonists, and direct oral anticoagulants, which must be recognized, monitored, and managed. During extracorporeal circulation, appropriate anticoagulation, most commonly with heparin, is required to maintain blood flow and avoid thrombotic complications. However, anticoagulation and other effects of extracorporeal circuits can also have an undesired consequence of bleeding. Extracorporeal circulation leads to coagulopathy that may require therapy with blood products such as platelets, cryoprecipitate, and plasma in case a patient bleeds. Platelet dysfunction related to exposure to a foreign circuit is a primary concern, as is the development of acquired von Willebrand syndrome, which frequently remains undetected on routine testing. Hemorrhagic complications in ECMO, such as intracranial hemorrhage, pulmonary hemorrhage, and hemithorax, can occur. Hemostatic agents including antifibrinolytics, desmopressin, fibrinogen concentrates, and other factor concentrates may be needed to achieve hemostasis in these often-challenging patients. Managing bleeding on extracorporeal support requires careful monitoring and a thoughtful approach.

Original languageEnglish (US)
Pages (from-to)62-72
Number of pages11
JournalSeminars in thrombosis and hemostasis
Volume46
Issue number1
DOIs
StatePublished - 2020

Keywords

  • bleeding
  • cardiopulmonary bypass
  • CPB
  • ECMO
  • extracorporeal membrane oxygenation
  • review

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine

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