Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA.
Pediatr Crit Care Med. 2021 Jun 1;22(6):542-552. doi: 10.1097/PCC.0000000000002698.
Anticoagulation plays a key role in the management of children supported with extracorporeal membrane oxygenation. However, the ideal strategy for monitoring anticoagulation remains unclear. Our objective was to evaluate the utility of laboratory measures of anticoagulation in pediatric extracorporeal membrane oxygenation.
Retrospective cohort study.
Quaternary care academic children's hospital.
Children in a noncardiac PICU cannulated to extracorporeal membrane oxygenation in 2010-2016.
None.
Demographic data, laboratory values, and heparin doses were extracted from the enterprise data warehouse. Primary diagnoses, indications for cannulation, hemorrhagic and thrombotic complications, and survival outcomes were abstracted from the local registry used for Extracorporeal Life Support Organization reporting. Statistical models accounting for repeated measures using generalized estimating equations were constructed to evaluate correlations between heparin doses and laboratory values; among laboratory values; and between heparin dose or laboratory values and clinical outcomes. One hundred thirty-three unique patients-78 neonates and 55 older patients-were included in the study. There was no significant association between antifactor Xa level, activated partial thromboplastin time, activated clotting time, or heparin dose with hemorrhage or thrombosis (odds ratio ≅ 1 for all associations). There was weak-to-moderate correlation between antifactor Xa, activated partial thromboplastin time, and activated clotting time in both neonates and older pediatric patients (R2 < 0.001 to 0.456). Heparin dose correlated poorly with laboratory measurements in both age groups (R2 = 0.010-0.063).
In children supported with extracorporeal membrane oxygenation, heparin dose correlates poorly with common laboratory measures of anticoagulation, and these laboratory measures correlate poorly with each other. Neither heparin dose nor laboratory measures correlate with hemorrhage or thrombosis. Further work is needed to identify better measures of anticoagulation in order to minimize morbidity and mortality associated with extracorporeal membrane oxygenation.
抗凝在体外膜氧合支持的儿童管理中起着关键作用。然而，监测抗凝的理想策略仍不清楚。我们的目的是评估实验室抗凝措施在儿科体外膜氧合中的应用。
回顾性队列研究。
四级保健学术儿童医院。
2010 年至 2016 年期间在非心脏 PICUs 中接受体外膜氧合插管的儿童。
无。
从企业数据仓库中提取人口统计学数据、实验室值和肝素剂量。从用于体外生命支持组织报告的本地注册处提取主要诊断、插管指征、出血和血栓形成并发症以及生存结果。使用广义估计方程构建了考虑重复测量的统计模型，以评估肝素剂量和实验室值之间的相关性；实验室值之间；肝素剂量或实验室值与临床结果之间。该研究共纳入 133 名患者，其中 78 名新生儿和 55 名年龄较大的患者。抗因子 Xa 水平、活化部分凝血活酶时间、活化凝血时间或肝素剂量与出血或血栓形成之间无显著相关性（所有相关性的比值比≈1）。在新生儿和较大的儿科患者中，抗因子 Xa、活化部分凝血活酶时间和活化凝血时间之间存在弱至中度相关性（R2 <0.001 至 0.456）。在两个年龄组中，肝素剂量与实验室测量值相关性较差（R2=0.010-0.063）。
在接受体外膜氧合支持的儿童中，肝素剂量与常用的抗凝实验室测量值相关性较差，并且这些实验室测量值之间相关性也较差。肝素剂量和实验室测量值均与出血或血栓形成无关。需要进一步研究以确定更好的抗凝措施，以最大限度地降低与体外膜氧合相关的发病率和死亡率。
