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Updated: Oct 7, 2025
03:40
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
466
Antimicrobial Prophylaxis and Anticoagulation Therapy in Pediatric ECMO: A Survey Study
Cierra A Frazier1, Brittany M Scott1, Peter N Johnson2
1Xavier University of Louisiana College of Pharmacy (BMS, CAF, JML), New Orleans, LA.
Summary
Most pediatric intensive care units use antimicrobial prophylaxis and heparin for extracorporeal membrane oxygenation (ECMO) patients. However, significant variations exist in antimicrobial regimens and anticoagulation monitoring, including antithrombin III (AT III) use.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Cardiovascular Support
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support technology used in critically ill children.
- Optimizing antimicrobial and anticoagulation therapies is crucial for patient outcomes during ECMO.
Purpose of the Study:
- To characterize current antimicrobial and anticoagulation practices in pediatric health systems utilizing ECMO.
- To identify common prophylactic antimicrobial agents and first- and second-line anticoagulants.
- To assess laboratory monitoring and antithrombin III (AT III) administration protocols.
Main Methods:
- An anonymous electronic survey was distributed to pediatric pharmacy networks.
- The survey collected data on health system demographics, antimicrobial prophylaxis, and anticoagulation strategies during ECMO.
- Descriptive statistics were used to analyze the collected data.
Main Results:
- 38 respondents from 33 health systems participated, primarily from pediatric ICUs.
- 73.6% of units use antimicrobial prophylaxis (cefazolin monotherapy most common).
- Heparin is the primary anticoagulant (92.1%), with bivalirudin as the second-line (63.2%). 94.7% use AT III with heparin.
Conclusions:
- The majority of surveyed centers employ antimicrobial prophylaxis for ECMO, though regimens vary.
- Heparin is the predominant anticoagulant, but inconsistencies in laboratory monitoring and AT III use were observed.
- Further standardization of these critical therapies may improve ECMO patient care.
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