Review Article

Intensive Care Medicine

, Volume 21, Issue 1, pp 84-93

Maintaining blood flow in the extracorporeal circuit: haemostasis and anticoagulation

  • A. R. WebbAffiliated withBloomsbury Institute of Intensive Care Medicine, Meddlesex Hospital
  • , M. G. MythenAffiliated withBloomsbury Institute of Intensive Care Medicine, Meddlesex Hospital
  • , D. JacobsonAffiliated withBloomsbury Institute of Intensive Care Medicine, Meddlesex Hospital
  • , I. J. MackieAffiliated withDepartment of Haematology, UCL Medical School

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Abstract

Objectives

To review the methods and developments in maintaining extracorporeal circuits in critically ill patients.

Design

The review includes details of the pathophysiological processes of haemostasis and coagulation in critically ill patients, methods of maintaining blood flow in the extracorporeal circuit and methods of monitoring anticoagulation agents used.

Setting

Information is relevant to the management of critically ill patients requiring extracorporeal renal and respiratory support and cardiopulmonary bypass.

Conclusions

Heparin is the mainstay of anticoagulation for the extracorporeal circuit although the complex abnormalities of the coagulation system in critically ill patients are associated with a considerable risk of bleeding. Alternative therapeutic agents and physical strategies (prostacyclin, low molecular weight heparin, sodium citrate, regional anticoagulation, heparin bonding and attention to circuit design) may reduce the risk of bleeding but expense and difficulty in monitoring are disadvantages.

Key words

Extracorporeal circuits Anticoagulation Haemostasis Heparin Prostacyclin Citrate Aprotinin