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Management of Anticoagulation during Extracorporeal Membrane Oxygenation in Children

Madhuradhar Chegondi1,2, Niranjan Vijayakumar3, Balagangadhar R Totapally4,5

  • 1Division of Pediatric Critical Care Medicine, Stead Family Children's Hospital, University of Iowa, Iowa City, IA 52242, USA.

Pediatric Reports
|July 27, 2022
PubMed

Insights

Managing anticoagulation for pediatric Extracorporeal Membrane Oxygenation (ECMO) is complex. This review covers ECMO coagulation, current/new anticoagulants, and monitoring to improve outcomes for critically ill children.

Area of Science:

  • Pediatric Critical Care Medicine
  • Hematology
  • Cardiopulmonary Support

Background:

  • Extracorporeal Membrane Oxygenation (ECMO) is vital for pediatric severe cardiopulmonary failure, with increasing use globally.
  • Anticoagulation is essential to prevent circuit thrombosis but carries risks of bleeding and thrombosis, impacting mortality.
  • Maintaining hemostatic balance during pediatric ECMO is clinically challenging.

Purpose of the Study:

  • To review the pathophysiology of coagulation during ECMO in children.
  • To evaluate current and emerging anticoagulant agents used in pediatric ECMO.
  • To outline diagnostic monitoring strategies for anticoagulation in this population.

Main Methods:

  • Literature review of pathophysiology, anticoagulants, and monitoring in pediatric ECMO.
  • Analysis of current clinical practices and emerging research.
  • Identification of knowledge gaps and future research directions.

Main Results:

  • Significant variations exist in anticoagulation management and diagnostic monitoring for pediatric ECMO patients.
  • Heparin remains standard, but newer agents are being explored.
  • Effective anticoagulation monitoring is crucial for mitigating bleeding and thrombosis risks.

Conclusions:

  • Optimizing anticoagulation strategies and monitoring is critical for improving survival in pediatric ECMO.
  • Further research is needed to standardize protocols and evaluate novel anticoagulants.
  • Addressing knowledge gaps will enhance the safe and effective use of ECMO in critically ill children.

Keywords:
ECMOanticoagulationbleedingchildrenextracorporeal life supportextracorporeal membrane oxygenationthrombosis

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