Semin Thromb Hemost 2020; 46(01): 062-072
DOI: 10.1055/s-0039-3400273
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Zhe Amy Fang
1  Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
,
Amir Hassan Navaei
2  Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas
,
Lisa Hensch
2  Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas
,
Shiu-Ki Rocky Hui
2  Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas
3  Department of Pediatrics, Baylor College of Medicine, Houston, Texas
,
Jun Teruya
2  Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas
3  Department of Pediatrics, Baylor College of Medicine, Houston, Texas
4  Department of Medicine, Baylor College of Medicine, Houston, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
13 December 2019 (online)

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.