Issue |
J Extra Corpor Technol
Volume 50, Number 1, March 2018
|
|
---|---|---|
Page(s) | 30 - 37 | |
DOI | https://doi.org/10.1051/ject/201850030 | |
Published online | 15 March 2018 |
Original Articles
Anticoagulation Management during First Five Days of Infant-Pediatric Extracorporeal Life Support
* Center for Cardiovascular Sciences and Department of Anesthesia, Mayo Clinic, Rochester, Minnesota
† SUNY Upstate Medical University, Syracuse, New York
Address correspondence to: Kirk R. Bingham, MS, CCP, 63 Citation Dr., Farmington, UT 84025. E-mail: u0450281@utah.edu
Received:
29
August
2016
Accepted:
8
October
2017
Anticoagulation during infant-pediatric extracorporeal life support (ECLS) has been a topic of study for many years, but management of anticoagulation is still only partially understood. Adequate anticoagulation during ECLS is imperative for successful outcomes and understanding the individual variables that play part is crucial for properly implementing anticoagulation management strategies. The purpose of our study was to compare the relationships between the variables of activated partial thromboplastin time (aPTT), activated clotting time, international normalized ratio, bleeding, thrombus formation, kaolin + heparinase thromboelastograph alpha angle, kaolin thromboelastograph reaction time (KTEG R-time), heparin dose rates (HDR), antithrombin (AT), anti-Xa, bivalirudin dose rate, argatroban dose rate, interventions, and transfusions. We hypothesized that the relationship between measures of anticoagulation would be influenced by the AT levels, and a therapeutic aPTT (60–80 seconds) could be achieved by increasing, or maintaining, the overall AT above a specific threshold for infant-pediatric patients on ECLS. Thirty-five infant-pediatric patients underwent ECLS between January 2013 and January 2016. The median age was 39 days with an average weight of 3.9 ± 4.3 kg. ECLS parameters collected at least every 24 hours for the first five ECLS days. Parameters recorded by retrospective chart review were analyzed using linear regression and receiver operator characteristic (ROC) analysis. We were unable to report a significant correlation between optimal aPTT and HDR at various AT levels. However, ROC analysis suggested that to maintain an aPTT above 60 seconds, an AT threshold of 42% or higher was observed when the HDR was >12 U/kg/h ROC analysis also determined that no thrombus was associated with an aPTT >64 seconds and decreased bleeding was associated with a KTEG R-time below 30 minutes. Based on these findings, we report multiple correlations that may help develop future standardized infant-pediatric ECLS anticoagulation protocols.
Key words: extracorporeal life support (ECLS) / anticoagulation / pediatric / infant / extracorporeal membrane oxygenation (ECMO) / antithrombin / heparin / bivalirudin / argatroban
© 2018 AMSECT
Current usage metrics show cumulative count of Article Views (full-text article views including HTML views, PDF and ePub downloads, according to the available data) and Abstracts Views on Vision4Press platform.
Data correspond to usage on the plateform after 2015. The current usage metrics is available 48-96 hours after online publication and is updated daily on week days.
Initial download of the metrics may take a while.