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Thromboelastography in Children Undergoing Extracorporeal Membrane Oxygenation
Wataru Sakai1, Tomohiro Chaki2, Yuki Ogasawara3
1Wataru Sakai is an adjunct assistant professor, pediatric intensive care unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan, and Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo.
Insights
Thromboelastography significantly reduced critical complications in children on extracorporeal membrane oxygenation (ECMO) compared to conventional tests. This approach offers a safer method for managing anticoagulation in pediatric ECMO patients.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Cardiovascular Surgery
Background:
- Children on extracorporeal membrane oxygenation (ECMO) face risks of bleeding and clotting issues, including intracranial hemorrhage.
- Current monitoring of anticoagulation during pediatric ECMO relies on conventional tests, with limited data on their efficacy.
- Thromboelastography (TEG) is a potential tool for anticoagulation management, but its use in pediatric ECMO is not well-established.
Purpose of the Study:
- To compare the incidence of critical complications in children receiving ECMO.
- To evaluate anticoagulation management using thromboelastography versus conventional coagulation tests.
- To assess the impact of different anticoagulation monitoring strategies on patient outcomes.
Main Methods:
- A single-center observational study (prospective and retrospective) involving pediatric patients (<18 years) requiring ECMO.
- Comparison of outcomes between a group managed with conventional tests (ACT, fibrinogen, platelets) and a group managed with TEG.
- Primary outcome: critical hemorrhage or pump failure leading to treatment cessation.
Main Results:
- The study included 17 patients in each group (conventional and TEG).
- The TEG group experienced significantly fewer critical complications (11%) compared to the conventional group (59%) (OR, 10.71; P = .01).
- While 30-day survival was higher in the TEG group, the difference was not statistically significant (P = .08).
Conclusions:
- Managing anticoagulation with thromboelastography in pediatric ECMO patients led to a lower frequency of critical complications.
- TEG demonstrates potential as a superior method for anticoagulation monitoring in this vulnerable population.
- Further research may confirm improved survival rates with TEG-guided anticoagulation.
Background:
Children undergoing extracorporeal membrane oxygenation (ECMO) are at risk of hematologic and coagulation complications, including intracranial hemorrhage. Thromboelastography is used to monitor anticoagulation in patients receiving ECMO, but no data for its use in children are available.
Objective:
To evaluate the incidence of complications when managing anticoagulation with thromboelastography or with conventional coagulation tests (activated clotting time, plasma fibrinogen level, and platelet count) among children receiving venoarterial or venovenous ECMO.
Methods:
This single-center, prospective, retrospective, observational study included patients less than 18 years old who required ECMO. Outcomes were compared between a conventional test group and a thromboelastography group. The primary outcome was critical hemorrhage or pump failure leading to treatment termination.
Results:
Each group included 17 patients. Twenty-one patients (17 in the conventional test group, 4 in the thromboelastography group) were enrolled retrospectively. Thirteen patients (all in the thromboelastography group) were enrolled prospectively beginning December 26, 2022. Patient age did not differ between groups (median [IQR] age, 2 [0-6] months). Significantly fewer critical complications occurred in the thromboelastography group (11%) than in the conventional test group (59%) (odds ratio, 10.71; 95% CI, 1.84-62.5; P = .01). The 30-day survival rate after ECMO was higher in the thromboelastography group than in the conventional test group, but the difference was not significant (P = .08).
Conclusions:
Managing anticoagulation with thromboelastography, as compared with conventional tests, decreased the frequency of critical complications among children undergoing ECMO.
