TY - JOUR
T1 - Anticoagulation practices associated with bleeding and thrombosis in pediatric extracorporeal membrane oxygenation; a multi-center secondary analysis
AU - Bailly, David K.
AU - Reeder, Ron W.
AU - Muszynski, Jennifer A.
AU - Meert, Kathleen L.
AU - Ankola, Ashish A.
AU - Alexander, Peta M.A.
AU - Pollack, Murray M.
AU - Moler, Frank W.
AU - Berg, Robert A.
AU - Carcillo, Joseph
AU - Newth, Christopher
AU - Berger, John
AU - Bell, Michael J.
AU - Dean, J. M.
AU - Nicholson, Carol
AU - Garcia-Filion, Pamela
AU - Wessel, David
AU - Heidemann, Sabrina
AU - Doctor, Allan
AU - Harrison, Rick
AU - Dalton, Heidi
AU - Zuppa, Athena F.
N1 - Funding Information:
We acknowledge the contributions of the following research coordinators and data coordinating center staff: Stephanie Bisping, BSN, RN, CCRP, Alecia Peterson, BS, and Jeri Burr, MS, RN, BC, CCRC, from University of Utah; Mary Ann DiLiberto, BS, RN, CCRC, and Carol Ann Twelves, BS, RN, from The Children’s Hospital of Philadelphia; Jean Reardon, MA, BSN, RN, and Elyse Tomanio, BSN, RN, from Children’s National Hospital; Aimee Labell, MS, RN, from Phoenix Children’s Hospital; Margaret Villa, RN, and Jeni Kwok, JD, from Children’s Hospital Los Angeles; Mary Ann Nyc, BS, from UCLA Mattel Children’s Hospital; Ann Pawluszka, BSN, RN, and Melanie Lulic, BS, from Children’s Hospital of Michigan; Monica S. Weber, RN, BSN, CCRP, and Lauren Conlin, BSN, RN, CCRP, from University of Michigan; and Alan C. Abraham, BA, CCRC, from University of Pittsburgh Medical Center. We also acknowledge the contributions of Robert Tamburro, MD, and Tammara Jenkins, MSN, RN, from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services: U10HD050096, U10HD049981,U10HD049983, U10HD050012, U10HD063108, U10HD063114, and U01HD049934.
Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services: U10HD050096, U10HD049981,U10HD049983, U10HD050012, U10HD063108, U10HD063114, and U01HD049934.
Publisher Copyright:
© The Author(s) 2022.
PY - 2023/3
Y1 - 2023/3
N2 - 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.
AB - 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.
KW - anticoagulation
KW - bleeding
KW - extracorporeal membrane oxygenation
KW - pediatric
KW - thrombosis
UR - http://www.scopus.com/inward/record.url?scp=85125733055&partnerID=8YFLogxK
U2 - 10.1177/02676591211056562
DO - 10.1177/02676591211056562
M3 - Article
C2 - 35220828
AN - SCOPUS:85125733055
SN - 0267-6591
VL - 38
SP - 363
EP - 372
JO - Perfusion (United Kingdom)
JF - Perfusion (United Kingdom)
IS - 2
ER -