Anticoagulation Levels and Bleeding After Emergency Department Extracorporeal Cardiopulmonary Resuscitation

Abstract

We aimed to describe bleeding events associated with extracorporeal cardiopulmonary resuscitation (eCPR) using two institutional heparin protocols. In addition, we discuss current barriers to optimal anticoagulation in this critical population. Patients initiated on venoarterial membrane oxygenation (VA-ECMO) are at risk of bleeding and thrombosis; both conditions can lead to severe morbidity or mortality. Intravenous heparin is the preferred form of anticoagulation for VA-ECMO. Prior studies have found elevated activated partial thromboplastin time (aPTT) may be an independent risk factor for bleeding; however, many studies lack standardization of bleeding scores and optimal anticoagulation targets. All six patients initiated on VA-ECMO experienced at least one bleeding event. Of 71 aPTT levels collected, 44% were within therapeutic range, 18% were subtherapeutic, and 38% were supratherapeutic. There were no obvious correlation between aPTT levels and bleeding. Future studies are needed to evaluate anticoagulation strategies in this population.