55 – Anticoagulation of the ECMO Patient with Troy Seelhammer | EDECMO Podcast

The podcast explores the complexities of anticoagulation in ECMO patients, focusing on the evolution of circuit technology and its impact on anticoagulation strategies. Intensivist and anesthesiologist Troy Seelhammer from Mayo Clinic shares insights on balancing the need for anticoagulation with the risks of hemorrhage, emphasizing a framework that starts with patient assessment, circuit evaluation, and comprehensive lab testing, including viscoelastic assessments like TEG. The discussion highlights the shift towards bivalirudin as a first-line systemic anticoagulant at Mayo Clinic, citing its more predictable dose-response and benefits in reducing circuit laydown. Seelhammer advises caution with reversal agents like protamine and advocates for intentionality with any interventions that could cause tissue perturbation and bleeding.

Outlines

Part 1: Fundamentals, Circuit Technology

Part 2: Anticoagulant Agents, Lab Testing

Part 3: Hemorrhage Management, Clinical Framework

Part 4: Transfusion Strategy, Future Outlook

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55 – Anticoagulation of the ECMO Patient with Troy Seelhammer

EDECMO Podcast

Part 1: Fundamentals, Circuit Technology

Introduction to ECMO Anticoagulation: Importance and Recent Changes

Evolution of ECMO Circuits and the Necessity for Anticoagulation

Timing and Heparin Coating in ECMO Circuits

Heparin Coating Mechanisms and Future Coating Technologies

Flow Rates, Heparin Bolus, and the Initial ECMO Procedure

Part 2: Anticoagulant Agents, Lab Testing

Heparin as the Gold Standard: Limitations and Alternative Lab Tests

Bivalirudin as a First-Line Anticoagulant: Benefits and Mayo Clinic's Experience

Initiating ECMO with Bivalirudin and Managing Hemorrhaging Patients

Part 3: Hemorrhage Management, Clinical Framework

Framework for Managing Hemorrhage: Patient, Circuit, and Lab Testing

Managing Bleeding: When to Stop Heparin and Avoiding PCC

Protamine Dosing and Bivalirudin Management in Hemorrhage

Part 4: Transfusion Strategy, Future Outlook

Managing Factor Deficiencies and Platelets in ECMO Patients

Transfusion Thresholds and ECMO: Balancing Oxygenation and Allogeneic Exposure

Summary of ECMO Anticoagulation and the Risks of Procedures

55 – Anticoagulation of the ECMO Patient with Troy Seelhammer

EDECMO Podcast

Part 1: Fundamentals, Circuit Technology

00:13Introduction to ECMO Anticoagulation: Importance and Recent Changes

Introduction to ECMO Anticoagulation: Importance and Recent Changes

02:23Evolution of ECMO Circuits and the Necessity for Anticoagulation

Evolution of ECMO Circuits and the Necessity for Anticoagulation

04:41Timing and Heparin Coating in ECMO Circuits

Timing and Heparin Coating in ECMO Circuits

07:08Heparin Coating Mechanisms and Future Coating Technologies

Heparin Coating Mechanisms and Future Coating Technologies

09:39Flow Rates, Heparin Bolus, and the Initial ECMO Procedure

Flow Rates, Heparin Bolus, and the Initial ECMO Procedure

Part 2: Anticoagulant Agents, Lab Testing

12:23Heparin as the Gold Standard: Limitations and Alternative Lab Tests

Heparin as the Gold Standard: Limitations and Alternative Lab Tests

14:15Bivalirudin as a First-Line Anticoagulant: Benefits and Mayo Clinic's Experience

Bivalirudin as a First-Line Anticoagulant: Benefits and Mayo Clinic's Experience

16:49Initiating ECMO with Bivalirudin and Managing Hemorrhaging Patients

Initiating ECMO with Bivalirudin and Managing Hemorrhaging Patients

Part 3: Hemorrhage Management, Clinical Framework

18:05Framework for Managing Hemorrhage: Patient, Circuit, and Lab Testing

Framework for Managing Hemorrhage: Patient, Circuit, and Lab Testing

20:59Managing Bleeding: When to Stop Heparin and Avoiding PCC

Managing Bleeding: When to Stop Heparin and Avoiding PCC

23:34Protamine Dosing and Bivalirudin Management in Hemorrhage

Protamine Dosing and Bivalirudin Management in Hemorrhage

Part 4: Transfusion Strategy, Future Outlook

25:23Managing Factor Deficiencies and Platelets in ECMO Patients

Managing Factor Deficiencies and Platelets in ECMO Patients

27:11Transfusion Thresholds and ECMO: Balancing Oxygenation and Allogeneic Exposure

Transfusion Thresholds and ECMO: Balancing Oxygenation and Allogeneic Exposure

29:34Summary of ECMO Anticoagulation and the Risks of Procedures

Summary of ECMO Anticoagulation and the Risks of Procedures