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Analysis of Viscoelastic Testing in Pediatric Patients Using the Pediatric Extracorporeal Membrane Oxygenation

Cassondra L Burton1, Jamie M Furlong-Dillard, Kahir Jawad

  • 1From the Division of Pediatric Critical Care, Norton Children's Hospital, University of Louisville, Louisville, Kentucky.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|April 14, 2021
PubMed

Insights

Viscoelastic tests (VETs) like TEG and ROTEM are increasingly used in pediatric extracorporeal membrane oxygenation (ECMO) patients. VETs identified platelet dysfunction as common and showed bleeding patients receiving VETs needed more cryoprecipitate.

Area of Science:

  • Pediatric critical care medicine
  • Hemostasis and thrombosis
  • Extracorporeal membrane oxygenation (ECMO)

Background:

  • Viscoelastic tests (VETs), including thromboelastography (TEG) and rotational thromboelastometry (ROTEM), are gaining traction in managing anticoagulation for extracorporeal membrane oxygenation (ECMO) patients.
  • Understanding coagulopathies and their management in this vulnerable pediatric population is crucial for improving outcomes.

Purpose of the Study:

  • To describe common coagulopathies in pediatric ECMO patients undergoing VET.
  • To explore associations between VET parameters and traditional coagulation tests.
  • To compare blood product usage between pediatric ECMO patients who underwent VET and those who did not.

Main Methods:

  • Retrospective review of data from 265 pediatric ECMO patients (<20 years old) submitted to the Pediatric ECMO Outcomes Registry (PEDECOR).
  • Analysis included patients who underwent VET (77% of the cohort) and those who did not.
  • Statistical comparisons used chi-squared tests for categorical variables and Kruskal-Wallis/Wilcoxon rank-sum tests for continuous variables.

Main Results:

  • Platelet dysfunction was the most frequent abnormality identified by VETs (TEG: 30.8%, ROTEM: 9.7%).
  • Pediatric ECMO patients with bleeding who underwent VET received significantly more cryoprecipitate transfusions compared to those without VET (median 9.7 ml/kg vs. 5.1 ml/kg, p=0.0013).

Conclusions:

  • Viscoelastic testing is a valuable tool for identifying coagulopathies, particularly platelet dysfunction, in pediatric ECMO patients.
  • Further research is warranted to evaluate the role of VETs in managing ECMO complications and optimizing anticoagulation therapy.

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