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Hemostasis in neonatal ECMO.

Valeria Cortesi1,2, Genny Raffaeli1,2, Giacomo S Amelio1

  • 1Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

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Coagulation issues remain a major challenge in extracorporeal membrane oxygenation (ECMO), impacting patient outcomes. This review examines monitoring tests for ECMO-induced coagulopathy, focusing on point-of-care viscoelastic assays in neonates.

Keywords:
anticoagulation managementdevelopmental hemostasisneonatal ECMOpoint-of-care teststhrombosis

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Area of Science:

  • Cardiovascular Sciences
  • Hematology
  • Neonatal Medicine

Background:

  • Extracorporeal membrane oxygenation (ECMO) provides vital cardio-respiratory support but is associated with significant coagulation problems.
  • Contact phase activation due to blood exposure to non-endothelial surfaces triggers inflammation and coagulative derangements in ECMO patients.
  • Neonatal patients present unique challenges due to pre-existing hemostatic dysfunction and delicate clotting balance.

Purpose of the Study:

  • To review current monitoring tests for ECMO-induced coagulopathy.
  • To highlight the role of point-of-care viscoelastic assays in neonatal ECMO.
  • To identify knowledge gaps and areas for future research in ECMO anticoagulation management.

Main Methods:

  • Review of existing literature on ECMO-induced coagulopathy.
  • Analysis of current diagnostic tests and monitoring approaches.
  • Focus on viscoelastic assays as point-of-care tools for neonatal ECMO.

Main Results:

  • Coagulation derangements are a primary cause of morbidity and mortality in ECMO patients.
  • Unfractionated heparin (UFH) is the standard anticoagulation, but monitoring remains challenging.
  • Significant inter-institutional variability exists in diagnostic approaches for ECMO coagulopathy.

Conclusions:

  • Effective management of ECMO-induced coagulopathy requires a goal-directed antithrombotic strategy.
  • Point-of-care viscoelastic assays show promise for improving anticoagulation monitoring in neonatal ECMO.
  • Further research is needed to establish optimal monitoring algorithms and address current knowledge gaps.