Survival time of ECMO circuits on and off bleeding protocol: is there a higher risk of circuit clotting?

Area of Science:

• Cardiovascular Research
• Pediatric Critical Care Medicine
• Biomedical Engineering

Background:

• Bleeding is a significant complication during extracorporeal membrane oxygenation (ECMO).
• Institutions often employ bleeding protocols (BP), sometimes with aminocaproic acid (ACA), to manage bleeding risks.
• There is a clinical concern that these protocols may increase circuit thrombosis and reduce ECMO circuit lifespan.

Purpose of the Study:

• To evaluate the impact of a bleeding protocol (BP), with or without ε-amino caproic acid (ACA), on the survival time of the ECMO circuit.
• To determine if initiating a BP affects the rate of circuit thrombosis in ECMO patients.

Main Methods:

• Retrospective analysis of 164 ECMO patients treated between 2000 and 2008.
• Patients were categorized into three groups: standard care, bleeding protocol (BP), and bleeding protocol with ACA (BP+ACA).
• Circuit survival time was compared using Kaplan-Meier curves and log-rank tests, with thrombosis defined as circuit change.

Main Results:

• Mean circuit survival time was 10.5 days (standard), 8.6 days (BP), and 9.9 days (BP+ACA).
• No statistically significant difference in circuit survival time was found between the standard group and the BP group (p=0.12).
• No significant difference was observed between the standard group and the BP+ACA group (p=0.92).

Conclusions:

• The study found no evidence that implementing a bleeding protocol, with or without ACA, shortens ECMO circuit survival time.
• Circuit thrombosis should not be a primary concern when initiating a bleeding protocol for ECMO patients.
• Clinical decisions regarding bleeding protocols can be made without significant concern for reduced ECMO circuit longevity.