Strategies for Anticoagulation During Venovenous ECMO

Inclusion Criteria:

   1. Patient receiving V-V ECMO

   2. Patient is located in a participating unit of the Vanderbilt University Medical Center
   (VUMC) adult hospital.

Exclusion Criteria:

   1. Patient is pregnant

   2. Patient is a prisoner

   3. Patient is < 18 years old

   4. Patient underwent ECMO cannulation greater than 24 hours prior to screening

   5. Presence of an indication for systemic anticoagulation:

      1. Ongoing receipt of systemic anticoagulation

      2. Planned administration of anticoagulation for an indication other than ECMO

      3. Presence of or plan to insert an arterial ECMO cannula

   6. Presence of a contraindication to anticoagulation:

      1. Active bleeding determined by treating clinicians to make anticoagulation unsafe

      2. Major surgery or trauma less than 72 hours prior to randomization

      3. Known history of a bleeding diathesis

      4. Ongoing severe thrombocytopenia (platelet count < 30,000)

      5. History of heparin-induced thrombocytopenia (HIT)

      6. Heparin allergy

   7. Positive SARS-CoV-2 test within prior 21 days or high clinical suspicion for COVID-19

   8. The treating clinician determines that the patient's risks of thromboembolism or
   bleeding necessitate a specific approach to anticoagulation management during V-V ECMO