Phillips Ryan C, Shahi Niti, Leopold David, Levek Claire, Shirek Gabrielle, Hilton Sarah, Hyslop Rob, Gien Jason, Kinsella John P, Buckvold Shannon, Liechty Kenneth W, Kim John S, Marwan Ahmed I
Department of Surgery, Division of Pediatric Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
Department of Pediatrics, Division of Biostatistics, University of Colorado School of Medicine, Aurora, CO, USA.
Pediatr Surg Int. 2020 Sep;36(9):1027-1033. doi: 10.1007/s00383-020-04694-0. Epub 2020 Jun 30.
Congenital diaphragmatic hernia (CDH) can cause severe hemodynamic deterioration requiring support with extracorporeal membrane oxygenation (ECMO). ECMO is associated with hemorrhagic and thromboembolic complications. In 2015, we standardized anti-coagulation management on ECMO, incorporating thromboelastography (TEG) as an adjunct to manage hemostasis of CDH patients. The purpose of this study is to evaluate our blood product utilization, choice of blood product use in response to abnormal TEG parameters, and the associated effect on bleeding and thrombotic complications.
We retrospectively reviewed all CDH neonates supported by ECMO between 2008 and 2018. Blood product administration, TEG data, and hemorrhagic and thrombotic complications data were collected. We divided subjects into two groups pre-2015 and post-2015.
After 2015, platelet transfusion was administered for a low maximum amplitude (MA) more frequently (77% compared to 65%, p = 0.0007). Cryoprecipitate was administered less frequently for a low alpha-angle (28% compared to 41%, p = 0.0016). There was no difference in fresh frozen plasma use over time. After standardizing the use of TEG, we observed a significant reduction in hemothoraces (18% compared to 54%, p = 0.026).
Institutional standardization of anti-coagulation management of CDH neonates on ECMO, including the use of goal-directed TEG monitoring may lead to improved blood product utilization and a decrease in bleeding complications in neonates with CDH supported by ECMO.
LEVEL OF EVIDENCE/TYPE OF STUDY: Level III, Retrospective comparative study.
先天性膈疝（CDH）可导致严重的血流动力学恶化，需要体外膜肺氧合（ECMO）支持。ECMO与出血和血栓栓塞并发症相关。2015年，我们对ECMO的抗凝管理进行了标准化，将血栓弹力图（TEG）作为辅助手段来管理CDH患者的止血。本研究的目的是评估我们的血液制品使用情况、根据异常TEG参数选择的血液制品使用情况以及对出血和血栓并发症的相关影响。
我们回顾性分析了2008年至2018年间接受ECMO支持的所有CDH新生儿。收集血液制品使用情况、TEG数据以及出血和血栓并发症数据。我们将研究对象分为2015年前和2015年后两组。
2015年后，因最大振幅（MA）低而输注血小板的频率更高（分别为77%和65%，p = 0.0007）。因α角低而输注冷沉淀的频率更低（分别为28%和41%，p = 0.0016）。新鲜冰冻血浆的使用随时间无差异。在标准化TEG的使用后，我们观察到血胸显著减少（分别为18%和54%，p = 0.026）。
对接受ECMO的CDH新生儿进行抗凝管理的机构标准化，包括使用目标导向的TEG监测，可能会提高血液制品的利用率，并减少接受ECMO支持的CDH新生儿的出血并发症。
证据水平/研究类型：III级，回顾性比较研究。
