To determine associations between anticoagulation practices and
bleeding and
thrombosis during pediatric
extracorporeal membrane oxygenation (ECMO), we performed a secondary analysis of prospectively collected data which included 481 children (<19 years), between January 2012 and September 2014. The primary outcome was
bleeding or thrombotic events.
Bleeding events included a blood product transfusion >80 ml/kg on any day, pulmonary
hemorrhage, or intracranial
bleeding, Thrombotic events included pulmonary emboli, intracranial clot, limb
ischemia, cardiac clot, and arterial
cannula or entire circuit change.
Bleeding occurred in 42% of patients. Five percent of subjects thrombosed, of which 89% also bled. Daily
bleeding odds were independently associated with day prior activated clotting time (ACT) (OR 1.03, 95% CI= 1.00, 1.05, p=0.047) and
fibrinogen levels (OR 0.90, 95% CI 0.84, 0.96, p <0.001).
Thrombosis odds decreased with increased day prior
heparin dose (OR 0.88, 95% CI 0.81, 0.97, p=0.006). Lower ACT values and increased
fibrinogen levels may be considered to decrease the odds of
bleeding. Use of this single measure, however, may not be sufficient alone to guide optimal anticoagulation practice during ECMO.