Do you give heparin to your ECMO patients? Well, let's rethink this. This episode is All Things Anticoagulation! Zack talks with Troy Seelhammer, an intensivist from Mayo Clinic Rochester. He manages ECMO patients in his daily practice there. He has become a master of the subject of anticoagulation. He will talk about heparin, bilvalirudin, or maybe no anticoagulation. We talk about how TEG can affect our management. We talk about PCC and Protamine when bleeding just won't stop. He talks about the when to be aggressive and when to cut back. Below is a wonderful synopsis of Troy's thoughts on anticoagulation on pump.
Goal Heparin levels are far from perfect but some suggestions
APTT 1.5 to 2.5 times normal
ACT level – 180-220 seconds
Antithrombin Levels – next generation
Seelhammer doc on Bivalirudin – Bivalirudin & TEG During ECMO