Lab Management
from Anesthesia & Analgesia 2018;126(4):1262
Avoiding ICH
Watch the Lecture from Maryland CC Project
by Dr. Erik Osborn
eeosborn@aim.com
Risk Factors
- Low PLT
- Renal Failure
- Rapid Drop in CO2
- Shock
- Prior Anticoagulant Use
- Severe Coagulopathy
ECMO causes a multi-factorial bleeding dyscrasia
Heparin
1/3 Heparin is biologically active
the other 2/3 may have variable effects (inflammation, complement cascade, plt activation)
Use smallest amount possible
45-55 (60-80 in pts with confirmed clots)
Give a low bolus on initiation <=50 Units/kg
Many bleeds may preexist the ECMO, consider CT early on
ICH Prevention
Management of ICH
Auto-Regulatory Index
NIRS to MAP?????
Multimodal Neuro Monitoring
CT Pre, 24 hrs, 72 hrs
EEGS (cont. for first 72hrs)
TCDs
NIRS
Neurlogical Pupillary Index
Biomarkers-NSE, S100b, GFAP (mostly just at the research phase)
Who Should Get ECMO
- Reversible process or transplant candidate
- Good Neuro Outcome Possible
- Ability to tolerate anticoag
- Age-performance and functional status
- Exit Strategy exists
Reversal
If you give protamine, try to use 1/4 or 1/2 dose and see if that is enough