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The heparin bolus at connection is reasonably treated as optional rather than mandatory in ECPR, and a unit should decide in its protocol rather than at the syringe. Direction used; adjusted point estimate not used.
Heparin bolus at cannulation
DOI 10.1053/j.jvca.2026.01.025
Withholding the intravenous unfractionated heparin bolus at cannulation (systemic infusion started in both groups)
59 patients, one centre, retrospective; the adjusted estimate is not significant; contradicts the Red Book connection sequence, which permits a bolus as soon as the system is connected.
Activated partial thromboplastin time did not differ. Major bleeding (BARC grade 3 or above) in the first 24 hours 42.9% with the bolus versus 25.0% without, with more transfusion (median 4 versus 2 units, P = 0.003). Thrombotic events 14.3% versus 16.7%; no device-related thrombosis in either group. On multivariable analysis the trend persisted but was not significant, adjusted OR 2.26, P = 0.311.
59 adults undergoing emergent peripheral venoarterial cannulation, 2020 to 2024, single centre