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Updated: Oct 28, 2025
In Vitro Thrombosis Test for Ventricular Assist Devices
Published on: March 21, 2025
Use of rotational thromboelastometry to predict hemostatic complications in pediatric patients undergoing
Joppe G Drop1,2, Özge Erdem2, Enno D Wildschut2
1Department of Pediatric Hematology Erasmus Medical Center - Sophia Children's Hospital Rotterdam The Netherlands.
Insights
Pediatric extracorporeal membrane oxygenation (ECMO) patients face high risks of bleeding and thrombosis. Rotational thromboelastometry (ROTEM) and activated partial thromboplastin time (aPTT) help predict these complications, impacting survival.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Cardiopulmonary bypass
Background:
- High incidence of hemostatic complications in pediatric patients on ECMO.
- Optimal anticoagulation strategy in pediatric ECMO remains undefined.
Purpose of the Study:
- Investigate associations between hemostatic complications, coagulation tests, and clinical parameters in pediatric ECMO patients.
- Determine the impact of these factors on patient survival.
Main Methods:
- Retrospective cohort study of pediatric patients on centrifugal pump ECMO.
- Collected data: patient characteristics, risk factors, coagulation tests (ROTEM, aPTT, aXa).
- Logistic regression analysis for repeated measurements to assess thrombosis and bleeding risks.
Main Results:
- High cumulative incidences of thrombosis (43.5%) and bleeding (25.4%).
- Factors increasing thrombotic risk: lower ROTEM clot firmness, higher aPTT, younger age (<29 days), surgery, longer ECMO duration.
- Surgery and younger age (<29 days) associated with major bleeding.
- Hemostatic complications significantly decreased survival to hospital discharge (P = .009).
Conclusions:
- ROTEM, aPTT, and anti-factor Xa assay are valuable in predicting hemostatic complications in pediatric ECMO.
- Clinical factors like age and surgery also play a significant role.
- Understanding these predictors can potentially improve outcomes for pediatric ECMO patients.
Background:
The incidence of hemostatic complications in pediatric patients undergoing extracorporeal membrane oxygenation (ECMO) is high. The optimal anticoagulation strategy in children undergoing ECMO is unknown.
Objectives:
To study the association between hemostatic complications, coagulation tests, and clinical parameters in pediatric patients undergoing ECMO and their effect on survival.
Methods:
We performed a retrospective cohort study of pediatric patients undergoing centrifugal pump ECMO. Collected data included patient characteristics, risk factors, and coagulation test results. Statistical analysis was done using logistic regression analysis for repeated measurements. Dependent variables were thrombosis and bleeding, independent variables were rotational thromboelastometry (ROTEM), activated partial thromboplastin time (aPTT) and antifactor-Xa assay (aXa) results, ECMO duration, age <29 days, sepsis and surgery.
Results:
Seventy-three patients with 623 ECMO days were included. Cumulative incidences of thrombosis and bleeding were 43.5% (95% confidence interval [CI], 26.0%-59.8%) and 25.4% (95% CI, 13.4%-39.3%), respectively. A lower maximum clot firmness of intrinsic ROTEM (INTEM; odds ratio [OR], 0.946; 95% CI, 0.920-0.969), extrinsic ROTEM (OR, 0.945; 95% CI, 0.912-0.973), and INTEM with heparinase (OR, 0.936; 95% CI, 0.896-0.968); higher activated partial thromboplastin time aPTT; OR, 1.020; 95% CI, 1.006-1.024) and age <29 days (OR, 2.900; 95% CI, 1.282-6.694); surgery (OR, 4.426; 95% CI, 1.543-12.694); and longer ECMO duration (OR, 1.149; 95% CI, 1.022-1.292) significantly increased thrombotic risk. Surgery (OR, 2.698; 95% CI, 1.543-12.694) and age <29 days (OR 2.242, 95% CI 1.282-6.694) were significantly associated with major bleeding. Patients with hemostatic complications had significantly decreased survival to hospital discharge (P = .009).
Conclusion:
The results of this study help elucidate the role of ROTEM, aPTT, anti-factor Xa, and clinical risk factors in predicting hemostatic complications in pediatric patients undergoing ECMO.
