ID:55 FC-PC2-5 Association between Bleeding Complications and Thromboelastography during ECMO Management Background

Background: Bleeding complications are common during extracorporeal membrane oxygenation (ECMO) and are associated with adverse outcomes. Anticoagulation is typically monitored using activated partial thromboplastin time (APTT) and activated clotting time (ACT). At our institution, unfractionated heparin is adjusted to maintain a target APTT of 50–60 seconds. However, APTT does not always accurately reflect the anticoagulant effect of heparin. Thromboelastography (TEG), a viscoelastic assay, provides comprehensive assessment of whole-blood coagulation and allows monitoring of heparin effects. We examined the association between bleeding complications and TEG findings during veno-venous (V-V) ECMO. Methods: We retrospectively analyzed patients who underwent V-V ECMO for severe respiratory failure between March 2021 and September 2024. Of 38 patients, 36 were included after excluding missing data. Patients were divided into bleeding (n = 18) and non-bleeding (n = 18) groups. Bleeding complications were defined as events requiring heparin discontinuation and/or surgical intervention. In the bleeding group, data up to the day of bleeding onset were analyzed; in the non-bleeding group, data from the entire ECMO period were analyzed. Heparin dose, APTT, and TEG parameters were compared. Results: Median heparin dose did not differ between groups (700 [500–900] vs. 640 [300–800] U/h, p = 0.08). Median APTT values were similar (50.0 [45.0–57.1] vs. 50.4 [45.0–57.7] seconds, p = 0.57). In contrast, ΔR-time was significantly prolonged in the bleeding group (18.5 [9.1–50.0] vs. 12.1 [3.0–27.5] minutes, p < 0.01). Conclusions: ΔR-time may identify excessive heparin anticoagulation not detected by APTT alone. TEG-guided monitoring may help reduce bleeding complications during ECMO. Further studies are needed to define the optimal ΔR-time range while balancing circuit thrombosis risk.