1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN. 2Division of Pediatric Hematology Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN. 3Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN. 4Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN. 5Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN. 6Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN.
Pediatr Crit Care Med. 2015 Jan;16(1):66-74. doi: 10.1097/PCC.0000000000000278.
To determine if a comprehensive extracorporeal membrane oxygenation anticoagulation monitoring protocol results in fewer hemorrhagic complications, reduced blood product usage, and increased circuit life.
In September 2011, we augmented our standard extracorporeal membrane oxygenation laboratory protocol to include anti-factor Xa assays, thromboelastography, and antithrombin measurements. We performed a retrospective chart review to determine outcomes for patients placed on extracorporeal membrane oxygenation prior to and after the initiation of our anticoagulation laboratory protocol.
Tertiary care, academic children's hospital.
All patients who were placed on extracorporeal membrane oxygenation at our institution from January 1, 2007, to September 30, 2013.
None.
There were 261 extracorporeal membrane oxygenation runs before the initiation of the protocol and 105 extracorporeal membrane oxygenation runs after the initiation of the protocol. There were no major changes to our extracorporeal membrane oxygenation circuit or changes to our transfusion threshold during the study period. The indication for extracorporeal membrane oxygenation, age, and severity of illness of the patients were similar before and after protocol initiation. Median blood product usage for packed RBCs, fresh frozen plasma, platelets, and cryoprecipitate decreased significantly after protocol initiation. The occurrence of cannula site bleeding decreased from 22% to 12% (p = 0.04), and surgical site bleeding decreased from 38% to 25% (p = 0.02). Median extracorporeal membrane oxygenation circuit life increased from 3.6 to 4.3 days (p = 0.02). A trend toward increased patient survival was noted, but it did not reach statistical significance.
We demonstrate an association between an extracorporeal membrane oxygenation anticoagulation laboratory protocol using anti-factor Xa assays, thromboelastography, and antithrombin measurements and a decrease in blood product transfusion, a decrease in hemorrhagic complications, and an increase in circuit life. To our knowledge, this is the first study to demonstrate clinical benefit associated with the use of these laboratory values for patients on extracorporeal membrane oxygenation.
确定综合体外膜肺氧合抗凝监测方案是否会减少出血并发症、减少血液制品的使用并延长回路寿命。
2011 年 9 月，我们在标准体外膜肺氧合实验室方案中增加了抗因子 Xa 测定、血栓弹性描记术和抗凝血酶测量。我们进行了回顾性图表审查，以确定在我们抗凝实验室方案启动之前和之后接受体外膜肺氧合的患者的结果。
三级保健，学术儿童医院。
2007 年 1 月 1 日至 2013 年 9 月 30 日期间在我们机构接受体外膜肺氧合的所有患者。
无。
在方案启动前有 261 例体外膜肺氧合运行，在方案启动后有 105 例体外膜肺氧合运行。在研究期间，我们的体外膜肺氧合回路没有重大变化，也没有改变我们的输血阈值。体外膜肺氧合的适应证、年龄和患者的疾病严重程度在方案启动前后相似。方案启动后，浓缩红细胞、新鲜冷冻血浆、血小板和冷沉淀的血液制品用量中位数显著下降。导管部位出血的发生率从 22%降至 12%（p = 0.04），手术部位出血的发生率从 38%降至 25%（p = 0.02）。体外膜肺氧合回路的中位寿命从 3.6 天增加到 4.3 天（p = 0.02）。观察到患者生存率有增加的趋势，但未达到统计学意义。
我们证明了使用抗因子 Xa 测定、血栓弹性描记术和抗凝血酶测量的体外膜肺氧合抗凝实验室方案与血液制品输注减少、出血并发症减少和回路寿命延长之间存在关联。据我们所知，这是第一项证明这些实验室值用于体外膜肺氧合患者的临床益处的研究。
