Through a series of case studies, this session will demonstrate strategies to manage hemostasis in patients on extracorporeal life support (ECLS) as well as identify gaps in knowledge that require further research. Cases will provide a practical guide to interpretation of laboratory testing for anticoagulation management, discuss traditional and alternative treatments for bleeding and DIC, and explain utility of plasma exchange in patients on ECLS. Scenarios will include discordant laboratory testing for heparin monitoring, bleeding in patients on alternative anticoagulants such as direct thrombin inhibitors (bivalirudin and argatroban), treatment of acquired von Willebrand disease, alternative treatments for bleeding such as nebulized or intrapulmonary antifibrinolytics, plasma exchange for patient with severe hemolysis or need for hemostasis reset, and treatment of purpura fulminans on ECLS. Additional cases will demonstrate transfusion needs on ECLS with discussion of research on RBC and platelet loss in the ECLS circuits. Finally, a visual case series will show the histologic structure and location of thrombi in ECLS circuits in a variety of scenarios providing insight into the mechanism of clot formation.
Interpret tests utilized for monitoring anticoagulation on extracorporeal life support (ECLS) circuits
Name 3 factors that account for the significant transfusion requirements for patients on ECLS
Apply alternative treatments other than blood component therapy for bleeding on ECLS