Anticoagulation and Pediatric Extracorporeal Membrane Oxygenation: Impact of Activated Clotting Time and Heparin Dose on Survival

Adherence to the recommended ACT of 180 to 220 seconds in pediatric ECMO patients may result in inadequate anticoagulation. Survival is improved by increased heparin administration independent of the ACT. The ACT may be too insensitive to maintain adequate long-term systematic anticoagulation, and other methods, such as heparin levels or functional parameters such as anti-Factor Xa activity or thrombin generation, should be investigated.