Anticoagulation practices associated with bleeding and thrombosis in pediatric extracorporeal membrane oxygenation; a multi-center secondary analysis
Year: 2022
Type: article
Abstract: To determine associations between anticoagulation practices and bleeding and thrombosis during pediatric extracorporeal membrane oxygenation (ECMO), we performed a secondary analysis of prospectively collected data which included 481 children (<19 years), between January 2012 and September 2014. The primary outcome was bleeding or thrombotic events. Bleeding events included a blood product transfusion >80 ml/kg on any day, pulmonary hemorrhage, or intracranial bleeding, Thrombotic events included pulmonary emboli, intracranial clot, limb ischemia, cardiac clot, and arterial cannula or entire circuit change. Bleeding occurred in 42% of patients. Five percent of subjects thrombosed, of which 89% also bled. Daily bleeding odds were independently associated with day prior activated clotting time (ACT) (OR 1.03, 95% CI= 1.00, 1.05, p =0.047) and fibrinogen levels (OR 0.90, 95% CI 0.84, 0.96, p <0.001). Thrombosis odds decreased with increased day prior heparin dose (OR 0.88, 95% CI 0.81, 0.97, p =0.006). Lower ACT values and increased fibrinogen levels may be considered to decrease the odds of bleeding. Use of this single measure, however, may not be sufficient alone to guide optimal anticoagulation practice during ECMO.
Source: Perfusion
Authors: David K Bailly, Ron W Reeder, Jennifer A Muszynski, Kathleen L Meert, Ashish A Ankola, Peta MA Alexander, Murray M Pollack, Frank W Moler, Robert A Berg, Joseph Carcillo, Christopher Newth, John Berger, Michael J Bell, J M Dean, Carol Nicholson, Pamela Garcia-Filion, David Wessel, Sabrina Heidemann, Allan Doctor, Rick Harrison, Heidi Dalton, Athena F Zuppa
Institutions: University of Utah, Nationwide Children's Hospital, Abigail Wexner Research Institute, Central Michigan University, Children's Hospital of Michigan, Boston Children's Hospital, Harvard University, Children's National, University of Michigan, Children's Hospital of Philadelphia, Children's Hospital of Pittsburgh, Children's Hospital Los Angeles, National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Phoenix Children's Hospital, University of Maryland, Baltimore, University of Maryland, College Park, University of California, Los Angeles, Mattel Children's Hospital, Inova Fairfax Hospital, Inova Children's Hospital
Language: English
Subfield: Biomedical Engineering
Field: Engineering
Domain: Physical Sciences
Open Access status: green
Awards: Neurodevelopmental Outcome after Cardiac Intensive Care, G1223667318, Collaborative Pediatric Critical Care Research Network, Physiologically-Based Pharmacokinetic Approach to Determine Dosing on Extracorporeal Life Support, Data Coordinating Center for the Collaborative Pediatric Critical Care Research Network, Controlled Trial of Two Lung Protective Ventilation Modes in Acute Lung Injury, Renewal Application for the Childrens Hospital of Pittsburgh Collaborative Pediatric Critical Care Research Network Site, Predicting Morbidity from Pediatric Critical Care, Pediatric Critical Care Research Network at Children's Hospital of Philadelphia, Collaborative Pediatric Critical Care Research Network At Children's Hospital of
OpenAlex ID: W4214751319