Extra Corporeal Life Support and Modification of Hemostasis

This is a multi-center, prospective, pilot cohort study, performed in the Intensive Care Units (ICUs) of the Ghent University Hospital, CHU Liège, University Hospital Brussels, and University Hospital Munster.

Each group will contain 20 subjects; in total there will be 40 subjects 2 groups of 20 patients GROUP 1: VV-ECMO n = 20 GROUP 2: VA-ECMO n = 20

• Demographics: age, sex, comorbidities, medication, reason for ECMO therapy

• Simplified Acute Physiology Score (SAPS) 3 at time of ICU admission.

• Components of the Sequential Organ Failure Assessment score daily (based on worst value of each component of the score)

• ECMO characteristics (place of cannulation, type of cannulas, oxygenator, bloodflow, gasflow and pressure registrations)

• Incidence and severity of bleeding, scored according to the GUSTO and BARC scores

• Coagulation profile: At inclusion (before heparine infusion is started), 2h after start of therapy, 24h, and 48h, and at specific moments of clinical suspicion of profound altered hemostasis. We defined a coagulation profile as a set of tests that includes

• prothrombin time (PT), international normalized ratio (INR)

• activated partial thromboplastin time (aPTT) and heparin ratio

• the fibrinogen level

• platelets

• ACT (iACT®, ...)

• D-dimer

• ROTEM (extem, intem, heptem) or TEG (Utrecht)

• AT III

• anti Xa

• Temperature daily (H/L) (core)

• Patient characteristics that may influence coagulation or the results of coagulation tests: body weight, Body Mass Index, drugs, C-reactive protein (as a marker for inflammation), Hemoglobin level, LDH, unconjugated bilirubin, (or haptoglobine or plasma free haemoglobin, if tested)

• Heparin dose