Continuous Antithrombin III Administration in Pediatric Veno-Arterial Extracorporeal Membrane Oxygenation

Area of Science:

• Pediatric Intensive Care Medicine
• Hematology
• Cardiovascular Surgery

Background:

• Extracorporeal membrane oxygenation (ECMO) requires careful anticoagulation management.
• Antithrombin III (ATIII) activity is crucial for effective anticoagulation during ECMO.
• Current intermittent ATIII dosing protocols may lead to suboptimal anticoagulation control.

Purpose of the Study:

• To evaluate the impact of a continuous ATIII infusion protocol on coagulation parameters in pediatric ECMO patients.
• To compare the effectiveness of continuous ATIII infusion versus intermittent ATIII dosing.

Main Methods:

• Retrospective case-control study design.
• Inclusion of all pediatric ECMO patients from January 2012 to July 2014.
• Comparison between patients receiving continuous ATIII infusion and historical controls receiving intermittent ATIII doses.

Main Results:

• Continuous ATIII infusion significantly increased time within the goal activated clotting time (ACT) range (71.9% vs 52.2%, p < 0.0001).
• Mean daily ATIII activity was higher in the continuous infusion group (77.3% vs 68.6%, p = 0.04).
• The continuous infusion group required a lower maximum heparin dose (p < 0.01) and showed a trend towards fewer heparin dose changes.

Conclusions:

• A continuous ATIII infusion protocol enhances anticoagulation control during pediatric ECMO.
• This protocol leads to more consistent therapeutic anticoagulation and potentially reduces blood product usage.
• Continuous ATIII infusion represents a superior strategy for managing ECMO-related coagulation compared to intermittent dosing.