Issue |
J Extra Corpor Technol
Volume 46, Number 1, March 2014
|
|
---|---|---|
Page(s) | 69 - 76 | |
DOI | https://doi.org/10.1051/ject/201446069 | |
Published online | 15 March 2014 |
Original Articles
Comparison of Routine Laboratory Measures of Heparin Anticoagulation for Neonates on Extracorporeal Membrane Oxygenation
* Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute, Columbus, Ohio
† Department of Surgery, Neonatal ECMO Program, Nationwide Children’s Hospital, Columbus, Ohio
‡ Division of Neonatology, Neonatal ECMO Program, Nationwide Children’s Hospital, Columbus, Ohio
Address correspondence to: Peter C. Minneci, MD, Center for Surgical Outcomes Research, Center Innovation in Pediatric Practice, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, JW4914, Columbus, OH 43205. E-mail: peter.minneci@nationwidechildrens.org
Received:
18
July
2013
Accepted:
7
January
2014
Our objective was to determine the best measure of heparin anticoagulation in neonatal patients on extracorporeal membrane oxygenation. Activated clotting time (ACT), activated partial thromboplastin time (aPTT), and antifactor Xa levels, along with corresponding heparin infusion rates and heparin bolus volumes, were collected from neonates receiving ECMO at our institution from 2008 to 2013. After natural log transformation of antifactor Xa, ACT, and aPTT, overall correlations between antifactor Xa levels and either ACT or aPTT and correlations between these tests and heparin infusion rates were evaluated using linear mixed models that accounted for both within- and between-patient correlations. Twenty-six neonates with an average weight of 3.4 kg (standard deviation .7) had a total of 27 separate ECMO runs during the study period. Within each patient, ACT (r = .40, p < .0001) and aPTT (r = .48, p < .0001) were both directly correlated with antifactor Xa levels. In contrast, between patients, only aPTT maintained a direct correlation with antifactor Xa (r = .61, p = .07), whereas ACT showed a statistically significant inverse correlation with antifactor Xa (r = −.48, p = .04). Compared with ACT, aPTT is more consistently reflective of the anticoagulation status both within each patient on ECMO and between patients treated with ECMO. Future efforts to develop standardized heparin infusion algorithms for patients on ECMO should consider using aPTT levels to monitor anticoagulation.
Key words: ECMO / partial thromboplastin time / heparin / activated clotting time
Presented at the 29th Annual Children’s National Medical Center Symposium on ECMO & Advanced Therapies for Respiratory Failure, Keystone, Colorado.
© 2014 AMSECT
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