ECMO with DIC
I would like your opinion on a subject in regards to ECMO. A patient comes into the ICU with ARDS and is cannulated onto VV ECMO. Two days later, the labs meet criteria for DIC. However, at this point, the patient is not oozing from any sites but has some bloody secretions from the ETT (most likely from the ARDS). Since we are basically causing the DIC with the ECMO circuit, heparin drip, and the products the patient needs, do we go after a DIC diagnosis from the provider or do we say it is not necessarily DIC because we are causing the labs to mimic DIC?
Comments
To my understanding there is no standardized definition of ECMO induced DIC. To be sure there is both increased clotting and increased bleeding in this scenario, from the ECMO, however the current ICD 10 code for DIC is describing a situation which develops from pathological insults and disease other than a combination of centrifugal pumps, mechanical trauma of the blood cells and impacts of anticoagulation. On the other hand, NOT reporting the DIC would mean you are missing a huge piece of clinically significant and resource intensive management having to be managed by Physician and facility. This underscores the need most likely to write the coordination and maintenance committee to request a new code for this condition. My advice, (take it for what it is worth) is to have a meeting with the physician champion and explain all of these issues with reporting the condition (or not reporting it) and do some education. I believe it will need to be the judgement of the treating provider as to if the situation has become significant enough to merit separate reporting as a new diagnosis. However, that judgement should be in the context of a proper understanding of what the code says, what the coding rules are, and what the standard for reporting a condition are.