ECMO Management for Neurosurgical Procedure/Operation

Pre-procedure circuit considerations:

• Maintain venous flow as high as possible (at least > 500 mL)

• Maintain flow rate as high as possible (at least > 60 mL/kg/min)
• Have a clear primed circuit available
• Assess the circuit frequently for fibrin and clots (at least hourly)

Pre-procedure anticoagulation considerations:

• Ensure anticoagulation is held
• If not on an antifibrinolytic, discuss with Neurosurgery and consider starting infusion and bolus per the ECMO Bleeding Algorithm
  • Aminocaproic acid: 100 mg/kg load, then 35 mg/kg/hour   - or -
  • Tranexamic acid: 10 - 20 mg/kg load, then 1 - 2 mg/kg/hour, adjust in renal failure
  • Preferred administration is to the patient. If access is unavailable, administer post-oxygenator

During Procedure: 

• Replace blood loss with packed red blood cells and fresh frozen plasma 1:1 ratio (use ECMO blood replacement order) for excessive bleeding

Following Procedure: 

• Refer to Post-Neurosurgical Intervention on ECMO

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.