International Survey on Anticoagulation Practices in Cardiopulmonary Bypass and ECMO

Background Anticoagulation practices during cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) are critical for the success of these procedures, yet there exists significant variation in these practices across different regions and among healthcare professionals and institutes. Methods An international survey was conducted targeting perfusionists and other healthcare professionals involved in CPB and ECMO procedures. The survey collected data on professional roles, geographic practice locations, heparin usage in prime solutions, initial and maintenance dosing, anticoagulation monitoring methods, and alternative anticoagulants for patients with Heparin-Induced Thrombocytopenia (HIT). Results Responses were received from professionals in over 20 countries, predominantly perfusionists. A majority of respondents use heparin in the prime solution for CPB, with typical initial doses ranging from 3,000 to 10,000 units. Heparin administration before initiating CPB typically varies between 300 to 400 Units/Kg whereas for ECMO, doses are generally lower. Monitoring of anticoagulation primarily employs Activated Clotting Time (ACT), with a notable number also using Thromboelastography (TEG). For HIT cases, Bivalirudin and Argatroban were the most cited alternatives. Conclusion The survey highlights a diversity of anticoagulation practices in CPB and ECMO across different regions, reflecting variations in clinical protocols, regional standards, and available resources. This diversity highlights the need for ongoing international dialogue and standardization efforts to optimize outcomes in patients who require these critical procedures.