The Impact and Statistical Analysis of a Multifaceted Anticoagulation Strategy in Children Supported on ECMO: Performance and Pitfalls

Journal of Intensive Care Medicine
Aaron D KesselTodd Sweberg

Abstract

We sought to determine whether the introduction of a new anticoagulation protocol improved the frequency with which target anticoagulation parameters were met in children supported with extracorporeal membrane oxygenation (ECMO). Additionally, we sought to correlate the results of various tests of anticoagulation with the heparin infusion dose (HID) for patients on ECMO and to evaluate the utility of these anticoagulation monitoring tests for the titration of the HID. A retrospective chart review of 18 patients who received ECMO at an academic tertiary care children's hospital. Nine patients who were managed using a new anticoagulation protocol were matched by age and diagnosis with 9 patients managed with the old protocol. We collected data relating to patient demographics, type of extracorporeal support, disease process, and incidence of bleeding or thrombosis. Anticoagulation parameters collected include the activated clotting time (ACT), activated partial thromboplastin time (aPTT), prothrombin time/international normalized ratio, anti-factor Xa level, and antithrombin 3 level along with the HID at each time point. Patient groups were compared using a Generalized Linear Mixed Model, a mixed model analysis of variance, and c...Continue Reading

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Citations

Apr 25, 2018·Circulation·Bradley S MarinoUNKNOWN American Heart Association Congenital Cardiac Defects Committee of the Council on Cardiovascular Disease in the Young; Counc
Sep 14, 2019·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Jamie S PenkHeidi J Dalton
Mar 7, 2020·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Katherine V Biagas, Christopher S Muratore
Mar 25, 2017·The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG·Winifred M StocktonCarolyn E Ragsdale
Nov 13, 2018·Frontiers in Pediatrics·Carles Bautista-RodriguezEduardo M Da Cruz
Jan 22, 2020·Critical Care : the Official Journal of the Critical Care Forum·Meghan M ChlebowskiPhilip C Spinella
Jul 8, 2017·Journal of Intensive Care Medicine·Heng Fan, Jian-Hua Zhu
Jan 6, 2018·Journal of Intensive Care Medicine·Aaron D Kessel, Todd M Sweberg

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