The use of recombinant tissue-type plasminogen activator in a newborn with an intracardiac thrombus developed during extracorporeal membrane oxygenation

Alejandro Garcia, Jeffrey W. Gander, Erica R. Gross, Ari Reichstein, Sujit S. Sheth, Charles J. Stolar, William Middlesworth

Research output: Contribution to journalArticle

Abstract

Extracorporeal membrane oxygenation (ECMO) support is often used to support infants and children with hemodynamic or respiratory failure. One of the major obstacles of safely treating a child with ECMO is balancing the risk of hemorrhage with the potential for thrombus development. Managing thrombosis in the setting of ECMO is challenging and has no defined algorithm. The use of recombinant tissue-type plasminogen activator (tPA) for thrombolysis has been previously described in cases where thrombi have developed despite adequate anticoagulation. In such situations, the risk of hemorrhage must be carefully balanced with the benefit of dissolving the clot and reestablishing flow. We present a case of an infant who required ECMO because of severe primary pulmonary hypertension and subsequently developed a right atrial thrombus adjacent to the ECMO cannula. The patient was treated with tPA with immediate improvement but had fatal intracranial hemorrhage almost 3 days after the tPA was administered. In this report, we review the current literature on tPA use during ECMO support and suggest a rational approach.

Original languageEnglish (US)
Pages (from-to)2021-2024
Number of pages4
JournalJournal of Pediatric Surgery
Volume46
Issue number10
DOIs
StatePublished - Oct 2011
Externally publishedYes

Fingerprint

Extracorporeal Membrane Oxygenation
Tissue Plasminogen Activator
Thrombosis
Newborn Infant
Plasminogen Activators
Hemorrhage
Intracranial Hemorrhages
Respiratory Insufficiency
Hemodynamics

Keywords

  • Alteplase
  • ECMO
  • Neonates

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

The use of recombinant tissue-type plasminogen activator in a newborn with an intracardiac thrombus developed during extracorporeal membrane oxygenation. / Garcia, Alejandro; Gander, Jeffrey W.; Gross, Erica R.; Reichstein, Ari; Sheth, Sujit S.; Stolar, Charles J.; Middlesworth, William.

In: Journal of Pediatric Surgery, Vol. 46, No. 10, 10.2011, p. 2021-2024.

Research output: Contribution to journalArticle

Garcia, Alejandro ; Gander, Jeffrey W. ; Gross, Erica R. ; Reichstein, Ari ; Sheth, Sujit S. ; Stolar, Charles J. ; Middlesworth, William. / The use of recombinant tissue-type plasminogen activator in a newborn with an intracardiac thrombus developed during extracorporeal membrane oxygenation. In: Journal of Pediatric Surgery. 2011 ; Vol. 46, No. 10. pp. 2021-2024.
@article{75a50cdd73334b2e853463c26e4297f7,
title = "The use of recombinant tissue-type plasminogen activator in a newborn with an intracardiac thrombus developed during extracorporeal membrane oxygenation",
abstract = "Extracorporeal membrane oxygenation (ECMO) support is often used to support infants and children with hemodynamic or respiratory failure. One of the major obstacles of safely treating a child with ECMO is balancing the risk of hemorrhage with the potential for thrombus development. Managing thrombosis in the setting of ECMO is challenging and has no defined algorithm. The use of recombinant tissue-type plasminogen activator (tPA) for thrombolysis has been previously described in cases where thrombi have developed despite adequate anticoagulation. In such situations, the risk of hemorrhage must be carefully balanced with the benefit of dissolving the clot and reestablishing flow. We present a case of an infant who required ECMO because of severe primary pulmonary hypertension and subsequently developed a right atrial thrombus adjacent to the ECMO cannula. The patient was treated with tPA with immediate improvement but had fatal intracranial hemorrhage almost 3 days after the tPA was administered. In this report, we review the current literature on tPA use during ECMO support and suggest a rational approach.",
keywords = "Alteplase, ECMO, Neonates",
author = "Alejandro Garcia and Gander, {Jeffrey W.} and Gross, {Erica R.} and Ari Reichstein and Sheth, {Sujit S.} and Stolar, {Charles J.} and William Middlesworth",
year = "2011",
month = "10",
doi = "10.1016/j.jpedsurg.2011.06.039",
language = "English (US)",
volume = "46",
pages = "2021--2024",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "10",

}

TY - JOUR

T1 - The use of recombinant tissue-type plasminogen activator in a newborn with an intracardiac thrombus developed during extracorporeal membrane oxygenation

AU - Garcia, Alejandro

AU - Gander, Jeffrey W.

AU - Gross, Erica R.

AU - Reichstein, Ari

AU - Sheth, Sujit S.

AU - Stolar, Charles J.

AU - Middlesworth, William

PY - 2011/10

Y1 - 2011/10

N2 - Extracorporeal membrane oxygenation (ECMO) support is often used to support infants and children with hemodynamic or respiratory failure. One of the major obstacles of safely treating a child with ECMO is balancing the risk of hemorrhage with the potential for thrombus development. Managing thrombosis in the setting of ECMO is challenging and has no defined algorithm. The use of recombinant tissue-type plasminogen activator (tPA) for thrombolysis has been previously described in cases where thrombi have developed despite adequate anticoagulation. In such situations, the risk of hemorrhage must be carefully balanced with the benefit of dissolving the clot and reestablishing flow. We present a case of an infant who required ECMO because of severe primary pulmonary hypertension and subsequently developed a right atrial thrombus adjacent to the ECMO cannula. The patient was treated with tPA with immediate improvement but had fatal intracranial hemorrhage almost 3 days after the tPA was administered. In this report, we review the current literature on tPA use during ECMO support and suggest a rational approach.

AB - Extracorporeal membrane oxygenation (ECMO) support is often used to support infants and children with hemodynamic or respiratory failure. One of the major obstacles of safely treating a child with ECMO is balancing the risk of hemorrhage with the potential for thrombus development. Managing thrombosis in the setting of ECMO is challenging and has no defined algorithm. The use of recombinant tissue-type plasminogen activator (tPA) for thrombolysis has been previously described in cases where thrombi have developed despite adequate anticoagulation. In such situations, the risk of hemorrhage must be carefully balanced with the benefit of dissolving the clot and reestablishing flow. We present a case of an infant who required ECMO because of severe primary pulmonary hypertension and subsequently developed a right atrial thrombus adjacent to the ECMO cannula. The patient was treated with tPA with immediate improvement but had fatal intracranial hemorrhage almost 3 days after the tPA was administered. In this report, we review the current literature on tPA use during ECMO support and suggest a rational approach.

KW - Alteplase

KW - ECMO

KW - Neonates

UR - http://www.scopus.com/inward/record.url?scp=80054752315&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80054752315&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2011.06.039

DO - 10.1016/j.jpedsurg.2011.06.039

M3 - Article

C2 - 22008344

AN - SCOPUS:80054752315

VL - 46

SP - 2021

EP - 2024

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 10

ER -