Tyler Hughes, BS, MD
Pediatric CCM Fellow
University of Texas-Health Science Center At San Antonio
San Antonio, Texas
Disclosure information not submitted.
Rebecca Treffalls, BS
Medical Student
School of Osteopathic Medicine, University of Incarnate Word, United States
Disclosure information not submitted.
Heidi Dalton, MD, FELSO
Director, ECLS Research and Program Development
Inova Fairfax Hospital
Scottsdale, Arizona
Disclosure information not submitted.
Oliver Karam, PhD, MD,
Professor, Division Chief
Virginia Commonwealth University Medical Center, United States
Disclosure information not submitted.
Andrew Meyer, MD, MS
Associate Professor with Tenure of Pediatric Critical Care
Department of Pediatrics, School of Medicine, UT Health Science Center At San Antonio, United States
Disclosure information not submitted.
Title: FACTORS ASSOCIATED WITH RECURRENT THROMBOSIS IN PEDIATRIC PATIENTS RECEIVING ECMO THERAPY
Introduction: This study aims to describe patient and clinical factors associated with thrombotic events affecting extracorporeal circuit and patient outcomes during pediatric extracorporeal membrane oxygenation.
Methods: A secondary analysis of a multi-center prospective study by the Pediatric Critical Care Research Network between 2012 and 2014 was performed. Patients under the age of 19 years receiving venoarterial extracorporeal membrane oxygenation (ECMO) were included. Of the 511 patients with complete demographics, 327 received at least four days of venoarterial ECMO therapy. Thrombotic events consisted of any clotting to a circuit component requiring intervention or patient related clots such has ischemic intracranial infarcts, pulmonary embolus, intracardiac thrombus, limb ischemia due to clot or aortopulmonary shunt clots. ECMO.
Results: Of the 327 patients, 44.6% of patients experienced a thrombotic event within the first 21 days of ECMO. 80.1% of patients who experienced a thrombotic event experienced it within the first 7 days of ECMO. On multivariable analysis, several factors were associated with experiencing more than one thrombotic event within 21 days of therapy: less than 31 days old (OR 1.63; CI, 1.16 - 2.28; p < 0.001), a higher antithrombin III (OR 1.01; CI, 1.01 - 1.02; p < 0.001), a higher anti-Xa (OR 6.07; CI, 3.37 - 10.919) and platelet transfusion volume by weight (OR 1.02; CI, 1.02 - 1.03). Gender, platelet count, fibrinogen level, INR, and often monitored coagulation labs were not significantly associated with more than one thrombotic event.
Conclusion: Previous reports of thrombotic complications occur in approximately one third of pediatric patients receiving extracorporeal membrane oxygenation therapy. Extracorporeal circuit replacement due to thrombosis can expose patients to adverse events and may lead to pulmonary, cardiac, and cerebral thromboembolic events. Identifying risk factors including neonatal age and frequency of platelet transfusion recipients could stratify anticoagulant therapy to improve outcomes.