Manual despre Prevenirea si Tratarea Infectiei cu COVID-19

34 Handbook of COVID-19 Prevention and Treatment
(4) Heparin-free operation may be performed in the following circumstances: the ECMO
support must continue but there is fatal bleeding or active bleeding that has to be
controlled; whole heparin coated loop and catheterization with blood flow > 3 L/min.
The recommend operation time < 24 hour. Replacement devices and consumables need
to be prepared.
(5) Heparin resistance. Under some conditions of heparin usage, aPTT is not able to
reach the standard and blood coagulation happens. In this case, the activity of plasma
antithrombin III (ATIII) needs to be monitored. If the activity reduces, fresh frozen
plasma needs to be supplemented to restore heparin sensitivity.
(6) Heparin induced thrombopenia (HIT). When HIT happens, we recommend to perform
plasma exchange therapy, or to replace heparin with argatroban.
7
Weaning from ECMO and Mechanical Ventilation
(1) If a patient treated by V-V ECMO combined with mechanical ventilation satisfies the
awake ECMO condition, we suggest to first try to remove the artificial airway, unless the
patient has ECMO related complications, or the expected time of removal of all the
assisting machines is less than 48 h.
(2) For a patient who has too much airway secretions that frequent artificial suction
clearance is needed, who is expected to have a long-term mechanical ventilation
support, who satisfies the conditions PaO2/FiO2 > 150 mmHg and time > 48 h, whose lung
image changes for the better, and whose damages related to mechanical ventilation
pressure have been controlled, the ECMO assistance may be removed. It is not
recommended to keep ECMO intubation.