CS Mott Children's Hospital, University of Michigan Hospital, Ann Arbor, MI, USA.
Pediatr Crit Care Med. 2013 Jun;14(5 Suppl 1):S37-42. doi: 10.1097/PCC.0b013e318292dfa7.
Extracorporeal life support applications have evolved considerably in recent years. However, the blood-biomaterial interface remains incompletely understood, and management of the acute inflammatory response and coagulation pathways continues to be challenging. At present, the gold standard for anticoagulation is unfractionated heparin. Since the inception of extracorporeal life support, the mainstay for anticoagulation monitoring has been activated clotting time. However, alongside the technological evolution in extracorporeal life support, the methods for monitoring heparin have also become more sophisticated, adding additional layers of complexity to creating an ideal safe protocol for anticoagulation during extracorporeal life support. To address this, the Extracorporeal Life Support Organization has formed an Anticoagulation Task Force to help direct both a consensus statement and potential guidelines within which the multiple monitoring methods can be customized for extracorporeal life support. One key question that remains in the use of these monitoring methods is whether the objective during extracorporeal life support is to anticoagulate the circuit to prevent thrombus formation within the extracorporeal device or whether it is to systemically anticoagulate the patient. This review details all current monitoring methods and highlights how they can be used during pediatric mechanical circulatory support.
体外生命支持应用近年来有了很大的发展。然而，血液-生物材料界面仍不完全被理解，急性炎症反应和凝血途径的管理仍然具有挑战性。目前，抗凝的金标准是普通肝素。自体外生命支持出现以来，抗凝监测的主要方法一直是激活凝血时间。然而，随着体外生命支持技术的发展，肝素监测方法也变得更加复杂，为体外生命支持期间抗凝创造理想的安全方案增加了更多的复杂性。为了解决这个问题，体外生命支持组织成立了一个抗凝工作组，以帮助指导共识声明和潜在的指南，其中可以根据体外生命支持定制多种监测方法。在使用这些监测方法时仍然存在一个关键问题，即在体外生命支持期间，目标是抗凝体外循环以防止体外设备内血栓形成，还是系统地抗凝患者。本综述详细介绍了所有当前的监测方法，并强调了它们在儿科机械循环支持中的应用。
