Drop Joppe G, Erdem Özge, Wildschut Enno D, van Rosmalen Joost, de Maat Moniek P M, Kuiper Jan-Willem, Houmes Robert Jan M, van Ommen C Heleen
Department of Pediatric Hematology Erasmus Medical Center - Sophia Children's Hospital Rotterdam The Netherlands.
Department of Intensive Care and Pediatric Surgery Erasmus University Medical Center - Sophia Children's Hospital Rotterdam The Netherlands.
Res Pract Thromb Haemost. 2021 Jul 14;5(5):e12553. doi: 10.1002/rth2.12553. eCollection 2021 Jul.
The incidence of hemostatic complications in pediatric patients undergoing extracorporeal membrane oxygenation (ECMO) is high. The optimal anticoagulation strategy in children undergoing ECMO is unknown.
To study the association between hemostatic complications, coagulation tests, and clinical parameters in pediatric patients undergoing ECMO and their effect on survival.
We performed a retrospective cohort study of pediatric patients undergoing centrifugal pump ECMO. Collected data included patient characteristics, risk factors, and coagulation test results. Statistical analysis was done using logistic regression analysis for repeated measurements. Dependent variables were thrombosis and bleeding, independent variables were rotational thromboelastometry (ROTEM), activated partial thromboplastin time (aPTT) and antifactor-Xa assay (aXa) results, ECMO duration, age <29 days, sepsis and surgery.
Seventy-three patients with 623 ECMO days were included. Cumulative incidences of thrombosis and bleeding were 43.5% (95% confidence interval [CI], 26.0%-59.8%) and 25.4% (95% CI, 13.4%-39.3%), respectively. A lower maximum clot firmness of intrinsic ROTEM (INTEM; odds ratio [OR], 0.946; 95% CI, 0.920-0.969), extrinsic ROTEM (OR, 0.945; 95% CI, 0.912-0.973), and INTEM with heparinase (OR, 0.936; 95% CI, 0.896-0.968); higher activated partial thromboplastin time aPTT; OR, 1.020; 95% CI, 1.006-1.024) and age <29 days (OR, 2.900; 95% CI, 1.282-6.694); surgery (OR, 4.426; 95% CI, 1.543-12.694); and longer ECMO duration (OR, 1.149; 95% CI, 1.022-1.292) significantly increased thrombotic risk. Surgery (OR, 2.698; 95% CI, 1.543-12.694) and age <29 days (OR 2.242, 95% CI 1.282-6.694) were significantly associated with major bleeding. Patients with hemostatic complications had significantly decreased survival to hospital discharge ( = .009).
The results of this study help elucidate the role of ROTEM, aPTT, anti-factor Xa, and clinical risk factors in predicting hemostatic complications in pediatric patients undergoing ECMO.
接受体外膜肺氧合（ECMO）治疗的儿科患者中，止血并发症的发生率很高。接受ECMO治疗的儿童的最佳抗凝策略尚不清楚。
研究接受ECMO治疗的儿科患者的止血并发症、凝血试验和临床参数之间的关联及其对生存的影响。
我们对接受离心泵ECMO治疗的儿科患者进行了一项回顾性队列研究。收集的数据包括患者特征、危险因素和凝血试验结果。使用逻辑回归分析对重复测量数据进行统计分析。因变量为血栓形成和出血，自变量为旋转血栓弹力图（ROTEM）、活化部分凝血活酶时间（aPTT）和抗Xa因子测定（aXa）结果、ECMO持续时间、年龄<29天、脓毒症和手术。
纳入73例患者，共接受623天的ECMO治疗。血栓形成和出血的累积发生率分别为43.5%（95%置信区间[CI]，26.0%-59.8%）和25.4%（95%CI，13.4%-39.3%）。内源性ROTEM（INTEM）的最大血凝块硬度较低（比值比[OR]，0.946；95%CI，0.920-0.969）、外源性ROTEM（OR，0.945；95%CI，0.912-0.973）以及使用肝素酶的INTEM（OR，0.936；95%CI，0.896-0.968）；活化部分凝血活酶时间aPTT较高（OR，1.020；95%CI，1.006-1.024）、年龄<29天（OR，2.900；95%CI，1.282-6.694）、手术（OR，4.426；95%CI，1.543-12.694）以及ECMO持续时间较长（OR，1.149；95%CI，1.022-1.292）均显著增加血栓形成风险。手术（OR，2.698；95%CI，1.543-12.694）和年龄<29天（OR，2.242；95%CI，1.282-6.694）与大出血显著相关。有止血并发症的患者出院生存率显著降低（P = 0.009）。
本研究结果有助于阐明ROTEM、aPTT、抗Xa因子和临床危险因素在预测接受ECMO治疗的儿科患者止血并发症中的作用。
