The Effects of Different Anticoagulation Strategies on Adult ECMO Patients

The use of extracorporeal membrane oxygenation (ECMO) in the treatment of acute respiratory failure patients has demonstrated improvement on patient survivability when compared to conventional treatment using mechanical ventilation. The purpose of this project was to complete a retrospective review of the data acquired over the six years the ECMO program has been operating at BUMCP in order to describe relationships between different anticoagulation strategies and patient outcomes. Data was collected from patients who were over the 18 years of age, treated with the veno-venous modality of ECMO, with an acute respiratory failure, and treated between May 1st, 2010 and June 31, 2016. Several dependent were analyzed seeking to explain potential relationships between different anticoagulation strategies and patient outcomes. Overall, the patients treated with veno-venous ECMO at BUMCP experienced a 55% survival to discharge rate. The group that received no heparin had the lowest survival to discharge rate at 33% which suggests that the use of heparin may be beneficial in ECMO patients. The titrated heparin group had the highest average hemoglobin (10.5 g/dl, SD 1.2) yet required the most units of PRBCs to be transfused (17.9 units, SD 21.6). The average ACT for this group was also highest at 174.8 (SD 24.7) suggesting that more transfusions were required due to bleeding complications from the use of heparin. A higher ACT also was associated with an increased length of stay. The only statistically significant relationship noted in the study was a positive relationship between ACT and hemoglobin level in the titrated heparin group (r = .450, p = .005) suggesting that as the ACT increased so did the patient’s average hemoglobin level. Conclusions: This study found evidence that suggested the use of heparin in ECMO patients may have a positive impact on their survival. Furthermore, patients who were exposed to a set rate of heparin experienced a greater survival to discharge rate and required fewer transfusions of PRBCs during their hospital stay. However, further research is needed to address potential co-morbidities that may have had an impact on patient survival as well as transfusion requirements