Extracorporeal 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