Chegondi Madhuradhar, Vijayakumar Niranjan, Totapally Balagangadhar R
Division of Pediatric Critical Care Medicine, Stead Family Children's Hospital, University of Iowa, Iowa City, IA 52242, USA.
Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA.
Pediatr Rep. 2022 Jul 11;14(3):320-332. doi: 10.3390/pediatric14030039.
Extracorporeal Membrane Oxygenation (ECMO) is often used in critically ill children with severe cardiopulmonary failure. Worldwide, about 3600 children are supported by ECMO each year, with an increase of 10% in cases per year. Although anticoagulation is necessary to prevent circuit thrombosis during ECMO support, bleeding and thrombosis are associated with significantly increased mortality risk. In addition, maintaining balanced hemostasis is a challenging task during ECMO support. While heparin is a standard anticoagulation therapy in ECMO, recently, newer anticoagulant agents are also in use. Currently, there is a wide variation in anticoagulation management and diagnostic monitoring in children receiving ECMO. This review intends to describe the pathophysiology of coagulation during ECMO support, review of literature on current and newer anticoagulant agents, and outline various diagnostic tests used for anticoagulation monitoring. We will also discuss knowledge gaps and future areas of research.
体外膜肺氧合（ECMO）常用于患有严重心肺衰竭的危重症儿童。在全球范围内，每年约有3600名儿童接受ECMO支持，病例数每年增加10%。尽管在ECMO支持期间进行抗凝对于预防回路血栓形成是必要的，但出血和血栓形成与显著增加的死亡风险相关。此外，在ECMO支持期间维持平衡的止血是一项具有挑战性的任务。虽然肝素是ECMO中的标准抗凝治疗药物，但最近也在使用更新的抗凝剂。目前，接受ECMO治疗的儿童在抗凝管理和诊断监测方面存在很大差异。本综述旨在描述ECMO支持期间凝血的病理生理学，回顾关于当前和更新的抗凝剂的文献，并概述用于抗凝监测的各种诊断测试。我们还将讨论知识空白和未来的研究领域。
