Long-term extracorporeal circulation management: the role of low- and high-range heparin ACT tests.

Modern management of extracorporeal circulation, especially during long-term support of post-cardiac surgical patients, remains challenging and requires optimal care of the patient's fluid balance and coagulation hemostasis for its successful outcome. The activated clotting time assay is one of the tests used to manage extracorporeal circulation and is available in a low- and high-range level. The question of which assay is more appropriate for procedures that require low to moderate heparin dosing is still unclear. We report our experience with a neonate diagnosed with hypoplastic left heart syndrome who needed emergent extracorporeal membrane oxygenation support for 13 days after Norwood stage I palliation using a Sano shunt. Although successful, bleeding complications prompted us to review our strategy for management of coagulation hemostasis.