Sood Shawn B, Walker Louisa Anne, Ramanujam Rangaraj, Hardison Daphne, Andrews Jennifer, Smith Andrew H, Bridges Brian C
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Tennessee, United States.
Department of Pediatrics, Vanderbilt University School of Medicine, Tennessee, United States.
J Pediatr Intensive Care. 2021 Apr 1;11(4):341-348. doi: 10.1055/s-0041-1726455. eCollection 2022 Dec.
We augmented our standard extracorporeal membrane oxygenation laboratory protocol to include antifactor Xa assays, thromboelastography, and antithrombin measurements. We performed a retrospective chart review to determine outcomes for patients placed on extracorporeal membrane oxygenation (ECMO) prior to and after the initiation of our anticoagulation laboratory protocol. A total of 663 consecutive ECMO runs were evaluated from January 1, 2007 to June 30, 2018. Of these patients, 252 were on ECMO prior to initiation of the anticoagulation laboratory protocol on September 1, 2011, and 411 patients were on ECMO after initiation of the protocol. There were no major changes to our extracorporeal membrane oxygenation circuit or changes to our transfusion threshold during this continuous study period. Transfusion utilization data revealed statistically significant decreases in almost all blood components, and a savings in blood component inflation-adjusted acquisition costs of 31% bringing total blood product cost-savings to $309,905 per year. In addition, there was an increase in survival to hospital discharge from 45 to 56% associated with the initiation of the protocol ( = 0.004). Our data indicate that implementation of a standardized ECMO anticoagulation protocol, which titrates unfractionated heparin infusions based on antifactor Xa assays, is associated with reduced blood product utilization, significant blood product cost savings, and increased patient survival. Future prospective evaluation is needed to establish an antifactor Xa assay-driven ECMO anticoagulation strategy as both clinically superior and cost-effective.
我们扩充了标准的体外膜肺氧合实验室方案，纳入抗Xa因子测定、血栓弹力图和抗凝血酶测量。我们进行了一项回顾性病历审查，以确定在我们的抗凝实验室方案启动前后接受体外膜肺氧合（ECMO）治疗的患者的结局。从2007年1月1日至2018年6月30日，共评估了663次连续的ECMO运行。在这些患者中，252例在2011年9月1日抗凝实验室方案启动前接受ECMO治疗，411例在方案启动后接受ECMO治疗。在这个连续研究期间，我们的体外膜肺氧合回路没有重大变化，输血阈值也没有改变。输血利用数据显示，几乎所有血液成分在统计学上都有显著减少，血液成分经通胀调整后的采购成本节省了31%，使每年血液制品总成本节省达309,905美元。此外，随着方案的启动，出院生存率从45%提高到了56%（P = 0.004）。我们的数据表明，实施基于抗Xa因子测定来滴定普通肝素输注的标准化ECMO抗凝方案，与血液制品利用率降低、血液制品成本显著节省以及患者生存率提高相关。未来需要进行前瞻性评估，以确立抗Xa因子测定驱动的ECMO抗凝策略在临床和成本效益方面的优越性。
