Factors Associated with Bleeding and Thrombosis in Children Receiving Extracorporeal Membrane Oxygenation

• DOI: 10.1164/rccm.201609-1945oc
• Publication Date: 2017-03-22T18:58:35Z
• Authors: Heidi J. Dalton; Ron Reeder; Pamela Garcia-Filion; Richard Holubkov; Robert A. Berg; Athena Zuppa; Frank W. Moler; Thomas Shanley; Murray M. Pollack; Christopher Newth; John Berger; David Wessel; Joseph Carcillo; Michael Bell; Sabrina Heidemann; Kathleen L. Meert; Richard Harrison; Allan Doctor; Robert F. Tamburro; J. Michael Dean; Tammara Jenkins; Carol Nicholson
• Keywords: Male; Adolescent; Respiratory System; Bioengineering; Clinical sciences; Hemorrhage; Cardiovascular; extracorporeal life support; Medical and Health Sciences; Cardiovascular medicine and haematology; Hemolysis; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network; 03 medical and health sciences; Extracorporeal Membrane Oxygenation; 0302 clinical medicine; Clinical Research; Cardiovascular Medicine and Haematology; Humans; cardiorespiratory failure; Prospective Studies; Preschool; Child; transfusion; Retrospective Studies; Pediatric; Heart Failure; Biomedical and Clinical Sciences; Prevention; Incidence; Evaluation of treatments and therapeutic interventions; Infant; Thrombosis; Hematology; 3. Good health; Heart Disease; Blood; Good Health and Well Being; 6.1 Pharmaceuticals; Child, Preschool; outcome; Female; hemolysis; Respiratory Insufficiency

Extracorporeal membrane oxygenation (ECMO) is used for respiratory and cardiac failure in children but complicated by bleeding thrombosis.(1) To measure the incidence of (blood loss requiring transfusion or intracranial hemorrhage) thrombosis during ECMO support; (2) to identify factors associated with these complications; (3) determine impact complications on patient outcome.This was a prospective, observational cohort study pediatric, cardiac, neonatal intensive care units eight hospitals, carried out from December 2012 September 2014.ECMO 514 consecutive patients under age 19 years. Demographics, anticoagulation practices, severity illness, circuitry components, bleeding, thrombotic events, outcome were recorded. Survival 54.9%. Bleeding occurred 70.2%, including hemorrhage 16%, independently higher daily risk mortality. Circuit component changes required 31.1%, patient-related clots 12.8%. Laboratory sampling contributed requirement 56.6%, sole reason at least one 42.2% patients. Pump type not thrombosis, hemolysis, Hemolysis predictive subsequent events. Neither hemolysis nor events increased mortality.The incidences are high support. major contributor ECMO. Strategies reduce different thresholds transfusion, may be appropriate subjects future trials improve outcomes this supportive therapy.