Reduced Intracranial Hemorrhage with Anticoagulation Guideline Implementation

Area of Science:

• Pediatric Critical Care Medicine
• Cardiovascular Surgery
• Hematology

Background:

• Hemorrhagic and thrombotic complications are frequent during extracorporeal membrane oxygenation (ECMO), impacting patient morbidity and mortality.
• Intracranial hemorrhage is a severe complication associated with significant mortality in patients on ECMO.

Purpose of the Study:

• To implement and evaluate standardized anticoagulation guidelines in a pediatric cardiothoracic intensive care unit (CTICU).
• To reduce the incidence of intracranial hemorrhage in pediatric patients undergoing ECMO.

Main Methods:

• Retrospective review of CTICU patients who received ECMO between January 2016 and December 2020.
• Comparison of clinical outcomes, specifically intracranial hemorrhage rates, before and after the implementation of standardized anticoagulation guidelines in Q4 2017.

Main Results:

• Before guideline implementation (Jan 2016-Dec 2017), 36% of ECMO runs (8/22) resulted in intracranial hemorrhage, with 88% of these patients expiring.
• After guideline implementation (Jan 2018-Dec 2020), the incidence of intracranial hemorrhage decreased to 14% (3/22), with a lower mortality rate of 33% for affected patients.

Conclusions:

• Standardized ECMO anticoagulation guidelines are effective in reducing intracranial hemorrhage in a pediatric CTICU setting.
• Successful implementation of these guidelines led to improved clinical outcomes and survival for high-risk pediatric patients on ECMO.