Manejo y monitorización de la anticoagulación en ECMO: una encuesta internacional: comunicación del Subcomité de Trombosis y Hemostasia Pediátrica y Neonatal del ISTH SSC

OBJECTIVES: The objective of this survey is to assess current practices in anticoagulation management, laboratory monitoring, and hematology involvement in extracorporeal membrane oxygenation (ECMO) patients. METHODS: A cross-sectional international survey distributed between April 2023 to November 2023 to members of Hemostasis and Thrombosis Research Society, International Society on Thrombosis and Haemostasis, and Extracorporeal Life Support Organization. Respondents were pediatric and adult physicians involved in the care of ECMO patients. RESULTS: Seventy-two survey responses were included with 83.3% of respondents being from an Extracorporeal Life Support Organization Institution. The respondents included both adult (41.7%) and pediatric (34.7%) physicians, as well as those who managed all age groups (23.6%). Approximately 53% reported including hematology as part of the care team. However, the majority reported that the hematologist is involved in complex cases only (72.2%). Respondents reported the routine utilization of an anticoagulation protocol (92%) and transfusion protocol (83%) to guide management decisions during ECMO therapy; however, management practices were variable. Both unfractionated heparin and bivalirudin were reported to be used routinely for anticoagulation at 92.2% and 52.9%, respectively. CONCLUSIONS: This survey demonstrated that hematology involvement for ECMO patients is still primarily for complicated cases. In addition, unfractionated heparin continued to be the anticoagulant of choice, with no significant changes in laboratory monitoring. Most centers utilize protocols for management, yet wide variability in ECMO management was again highlighted. Continued prospective and collaborative research efforts are needed to make advancements in treatment and outcomes, and to help streamline the care of this complex patient population.

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Una encuesta internacional transversal (abril a noviembre de 2023) sobre la anticoagulación en ECMO reunió 72 respuestas. El 92 % usaba rutinariamente un protocolo de anticoagulación y el 83 % uno transfusional; la heparina no fraccionada se usaba de forma rutinaria en el 92,2 % y la bivalirudina en el 52,9 %. La hematología participaba en cerca del 53 %, pero mayoritariamente solo en casos complejos (72,2 %). Los autores subrayan la amplia variabilidad y piden más investigación.

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