Division of Pediatric Critical Care Medicine, Central Michigan University College of Medicine, Children's Hospital of Michigan, Carl's Building Suite 4114, 3901 Beaubien Street, Detroit, MI 48201, USA.
Division of Hematology, Oncology and Stem Cell Transplantation, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago, Box #30, Chicago, IL 60611, USA.
Pediatr Clin North Am. 2022 Jun;69(3):441-464. doi: 10.1016/j.pcl.2022.01.009.
Extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs) are increasingly used in critically ill children. Despite improvements in mechanical design and clinical management, thromboembolic and hemorrhagic events remain significant causes of morbidity and mortality related to the use of both devices. Choice of anticoagulant agents and assays for monitoring continue to present challenges in management. In this review, we describe the incidence and risk factors for thrombosis and hemorrhage, the different types of anticoagulants currently in use, the assays available for monitoring anticoagulation, and management of thromboembolic and bleeding complications in children on mechanical circulatory support (MCS). We conclude by emphasizing the areas that need further study to minimize the risk for thrombosis and hemorrhage in the use of ECMO and VAD in children.
体外膜肺氧合 (ECMO) 和心室辅助装置 (VAD) 在危重症儿童中越来越多地被使用。尽管机械设计和临床管理得到了改进，但血栓栓塞和出血事件仍然是与这两种设备使用相关的发病率和死亡率的重要原因。抗凝药物的选择和监测检测方法在管理中仍然存在挑战。在这篇综述中，我们描述了血栓形成和出血的发生率和危险因素、目前使用的不同类型的抗凝剂、用于监测抗凝的检测方法，以及机械循环支持 (MCS) 中儿童的血栓栓塞和出血并发症的管理。最后，我们强调了需要进一步研究的领域，以最大限度地降低儿童使用 ECMO 和 VAD 时发生血栓形成和出血的风险。
