Cincinnati Children's Hospital Medical Center, Pediatric General and Thoracic Surgery, Cincinnati, OH, USA.
Cincinnati Children's Hospital Medical Center, Pediatric General and Thoracic Surgery, Cincinnati OH, USA.
J Pediatr Surg. 2022 Jun;57(6):1056-1061. doi: 10.1016/j.jpedsurg.2022.01.059. Epub 2022 Feb 14.
Extracorporeal membrane oxygenation (ECMO) profoundly impacts inflammatory and coagulation pathways, and strict monitoring is essential to guide therapeutic anticoagulation. Thromboelastography (TEG) offers a global evaluation of whole blood hemostatic system components and may be a valuable measurement of hemostatic function in these patients. There is a paucity of data correlating TEG parameters with standard measures of coagulation in heparinized pediatric patients.
Children on ECMO during a 10-year period were retrospectively reviewed. Standard measures of coagulation were matched to TEGs drawn within 30 min of each other.
Out of 296 unique patients with 331 ECMO runs, 74.3% (n = 246) had at least one set of matched laboratory samples for a total of 2502 matched samples. The aPTT correlated with R-time (p<0.001). Platelets and fibrinogen correlated with α-angle (p<0.001). Fibrinogen (p<0.001) and platelets (p<0.001) were each associated with maximum amplitude (MA). 158 (47.7%) patients had at least one bleeding complication, and 100 (30.2%) had at least one thrombotic complication. Interestingly, a decreasing MA was associated with increased thrombotic complications (p<0.001).
TEG correlated well with traditional measures of hemostasis in pediatric ECMO patients. However, there was not a clear benefit of the TEG over these other measures LEVEL OF EVIDENCE: III.
体外膜肺氧合（ECMO）对炎症和凝血途径有深远影响，严格监测对于指导治疗性抗凝至关重要。血栓弹力图（TEG）可全面评估全血止血系统成分，可能是评估这些患者止血功能的有价值的测量方法。肝素化儿科患者的 TEG 参数与标准凝血测量值相关的数据很少。
回顾性分析了 10 年间接受 ECMO 的儿童患者。将标准凝血测量值与彼此之间相差 30 分钟内的 TEG 进行匹配。
在 296 名具有 331 次 ECMO 运行的独特患者中，74.3%（n=246）至少有一组匹配的实验室样本，总计 2502 个匹配样本。APTT 与 R 时间相关（p<0.001）。血小板和纤维蛋白原与α角相关（p<0.001）。纤维蛋白原（p<0.001）和血小板（p<0.001）均与最大振幅（MA）相关。158（47.7%）名患者至少发生了一次出血并发症，100（30.2%）名患者至少发生了一次血栓并发症。有趣的是，MA 降低与血栓并发症增加相关（p<0.001）。
TEG 与儿科 ECMO 患者的传统止血测量值相关性良好。然而，TEG 并没有比这些其他测量值更有优势。
III。
