With the new advent of fully heparin bonded circuits, ECMO can be run without anticoagulation. However in many patients, this will lead to clotting of the oxygenator and possibly the circuit.
Heparin
In general, for patient without contraindications heparin targeted to a aPTT of 1.5-2 x baseline will be adequate (45-55).
In some patients a slightly higher aPTT of 60-80 will be chosen.
Trisodium Citrate
While there has been some animal work and a few case studies, the citrate anticoagulation protocols used for CRRT have not been transferred to ECMO use as of yet.
