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Heparin levels should be done after 6hrs on ECMO and at least once
per shift or following any major changes in patient/circuit bleeding or
thrombosis
Major Bleeding
Microdose heparin
Anti-Xa guided
Anticoagulation
(1ml/hr = 25u/kg/hr)
6 hrs
heparin by 5 u/kg/hr
30u/kg/hr
6 hrs
<0.4 u/ml
Target Anti-Xa
heparin by 5 u/kg/hr
>1 u/ml
heparin by 5 u/kg/hr
35u/kg/hr + FFP
6 hrs
40u/kg/hr + discuss
with consultant
Ensure ATIII till >80% predicted for age
(FFP or concentrated ATIII in needed)
heparin by 5 u/kg/hr
20u/kg/hr
heparin by 5 u/kg/hr
heparin by 5 u/kg/hr
Bleeding Protocol
Local bleeding from cannulae sites
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Step 1
ACT 180-250
AntiXa 0.4 to1.0u/ml
Step 2
ACT 180-250
AntiXa <0.4. to 0.6 u/ml
Step 3
ACT 180-250
AntiXa <0.4. to 0.6 u/ml
Step 4
ACT 180-250
AntiXa <0.4. to 0.6 u/ml
Step 5
Microdose Heparin10u/kg/hr
(Consultant decision only)
ACT >160*
AntiXa 0.3 to 0.5u/ml
Step 6
Ignore ACT
AntiXa 0.2 to 0.4u/ml