Anticoagulation monitoring during pediatric extracorporeal membrane oxygenation

Melania Bembea, Jamie Schwartz, Nilay Shah, Elizabeth Ann Colantuoni, Christoph U. Lehmann, Thomas Stephen Kickler, Peter Pronovost, John Strouse

Research output: Contribution to journalArticle

Abstract

The best method of monitoring anticoagulation during extracorporeal membrane oxygenation (ECMO) is unknown. We conducted a prospective observational study in a tertiary pediatric intensive care unit. Antifactor Xa, antithrombin (AT), and factor VIII activity (FVIII) were measured in blood samples collected at 6, 12, and every 24 hours, respectively, of ECMO. We enrolled 34 children who underwent 35 ECMO runs from April 2008 to September 2010. Activated clotting time (ACT) and heparin doses were higher, whereas antifactor Xa levels were lower in neonates compared to infants/children. Median antifactor Xa was 0.4 IU/ml, median AT was 60%, and median FVIII was 67%. Heparin infusion rate, antifactor Xa, and antithrombin (AT) increased, FVIII was stable, and ACT decreased with each day on ECMO. ACT had poor agreement with antifactor Xa (42%). AT was inversely correlated with ACT (r = -0.33), even after adjusting for heparin dose, and positively correlated with antifactor Xa (r = 0.57). This study emphasizes the age differences as well as the variability over days of coagulation monitoring assays during ECMO. ACT is poorly correlated with antifactor Xa and AT modifies the relationship between ACT and the heparin dose, indicating that results should be interpreted with caution when managing anticoagulation on ECMO. Additional studies are warranted to determine optimal ECMO anticoagulation monitoring.

Original languageEnglish (US)
Pages (from-to)63-68
Number of pages6
JournalASAIO Journal
Volume59
Issue number1
DOIs
StatePublished - Jan 2013

Fingerprint

Extracorporeal Membrane Oxygenation
Pediatrics
Oxygenation
Antithrombins
Membranes
Monitoring
Heparin
Factor VIII
Intensive care units
Pediatric Intensive Care Units
Coagulation
Observational Studies
Assays
Blood
Newborn Infant
Prospective Studies

Keywords

  • anticoagulation
  • antithrombin
  • ECMO
  • extracorporeal membrane oxygenation
  • heparin assay

ASJC Scopus subject areas

  • Biophysics
  • Biomaterials
  • Bioengineering
  • Biomedical Engineering
  • Medicine(all)

Cite this

Anticoagulation monitoring during pediatric extracorporeal membrane oxygenation. / Bembea, Melania; Schwartz, Jamie; Shah, Nilay; Colantuoni, Elizabeth Ann; Lehmann, Christoph U.; Kickler, Thomas Stephen; Pronovost, Peter; Strouse, John.

In: ASAIO Journal, Vol. 59, No. 1, 01.2013, p. 63-68.

Research output: Contribution to journalArticle

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