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Antithrombin use during pediatric cardiac extracorporeal membrane oxygenation admission: insights from a national
Salvatore R Aiello1, Saul Flores2, Megan Coughlin3
1Division of Cardiology, Advocate Children's Hospital, Chicago Medical School, Chicago, IL, USA.
Insights
Antithrombin supplementation in pediatric extracorporeal membrane oxygenation (ECMO) patients did not show clear clinical benefit. This study found antithrombin associated with increased mortality but reduced length of stay and costs.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular surgery
- Pharmacology
Background:
- Extracorporeal membrane oxygenation (ECMO) use is rising in pediatric patients, particularly those with complex congenital heart disease.
- Heparin is standard for anticoagulation during ECMO, with antithrombin sometimes added to enhance its effects.
- The clinical benefit of antithrombin supplementation in this population remains uncertain.
Purpose of the Study:
- To investigate the effects and clinical outcomes of antithrombin administration in pediatric patients undergoing ECMO.
- To determine if antithrombin supplementation impacts thrombosis, hemorrhage, mortality, length of stay, or costs in pediatric ECMO patients.
Main Methods:
- A large retrospective study utilizing the Pediatric Health Information System and Pediatric Health Information System+ databases (2004-2015).
- Included pediatric patients with congenital heart disease undergoing ECMO, divided into groups with and without antithrombin use.
- Collected data included demographics, diagnoses, procedures, comorbidities, length of stay, mortality, and billed charges.
Main Results:
- Out of 9,193 admissions, 9.4% received antithrombin.
- Antithrombin use was associated with significantly lower odds of venous thrombosis.
- However, antithrombin was linked to increased inpatient mortality, shorter length of stay, and decreased billed charges, with no significant association with hemorrhage.
Conclusions:
- Antithrombin administration in pediatric ECMO patients is associated with increased mortality, shorter length of stay, and reduced costs.
- The decreasing trend in antithrombin usage may reflect a lack of established clinical benefit.
- Findings suggest antithrombin may not be indicated for all pediatric ECMO patients.
Introduction:
The frequency of extracorporeal membrane oxygenation in pediatric patients continues to increase, especially in patients with complex congenital heart disease. Providing adequate anticoagulation is necessary for patients on extracorporeal membrane oxygenation and is achieved with adequate heparin administration. Antithrombin is administered to potentiate heparin's effects. However, the efficacy of antithrombin supplementation is unclear and a clear clinical benefit has not been established. We present a large retrospective study examining the effects of antithrombin on pediatric patients receiving extracorporeal membrane oxygenation.
Methods:
Data for this study were obtained from the Pediatric Health Information System and Pediatric Health Information System+ databases from 2004 to 2015. Pediatric patients receiving extracorporeal membrane oxygenation with a congenital heart disease diagnosis were included and divided into groups that did or did not utilize antithrombin. For all admissions, the following were captured: age of admission, gender, year of admission, length of stay, billed charges, inpatient mortality, the presence of specific congenital malformations of the heart, specific cardiac surgeries, and comorbidities.
Results:
A total of 9,193 admissions were included and 865 (9.4%) utilized antithrombin. Between groups, there were significantly different frequencies of co-morbidities, cardiac lesion types and antithrombin usage over the study period. There were significantly lower odds in the antithrombin group of venous thrombosis. Antithrombin was not significantly associated with hemorrhage; however, antithrombin was associated with increased inpatient mortality and a decrease in length of stay and billed charges.
Conclusion:
Antithrombin administration is associated with increased mortality, a shorter length of stay, and decreased billing cost. Recently, antithrombin usage has been decreasing-potentially due to the reported lack of clinical benefit. Together, these results reinforce that antithrombin may not be indicated for all pediatric extracorporeal membrane oxygenation patients.
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