TY - JOUR
T1 - Factors associated with bleeding and thrombosis in children receiving extracorporeal membrane oxygenation
AU - Dalton, Heidi J.
AU - Reeder, Ron
AU - Garcia-Filion, Pamela
AU - Holubkov, Richard
AU - Berg, Robert A.
AU - Zuppa, Athena
AU - Moler, Frank W.
AU - Shanley, Thomas
AU - Pollack, Murray
AU - Newth, Christopher
AU - Berger, John
AU - Wessel, David
AU - Carcillo, Joseph
AU - Bell, Michael
AU - Heidemann, Sabrina
AU - Meert, Kathleen L.
AU - Harrison, Richard
AU - Doctor, Allan
AU - Tamburro, Robert F.
AU - Dean, J. Michael
AU - Jenkins, Tammara
AU - Nicholson, Carol
N1 - Publisher Copyright:
Copyright © 2017 by the American Thoracic Society
PY - 2017/9/15
Y1 - 2017/9/15
N2 - Rationale: Extracorporeal membrane oxygenation (ECMO) is used for respiratory and cardiac failure in children but is complicated by bleeding and thrombosis. Objectives: (1) To measure the incidence of bleeding (blood loss requiring transfusion or intracranial hemorrhage) and thrombosis during ECMO support; (2) to identify factors associated with these complications; and (3) to determine the impact of these complications on patient outcome. Methods: This was a prospective, observational cohort study in pediatric, cardiac, and neonatal intensive care units in eight hospitals, carried out from December 2012 to September 2014. Measurements and Main Results: ECMO was used on 514 consecutive patients under age 19 years. Demographics, anticoagulation practices, severity of illness, circuitry components, bleeding, thrombotic events, and outcome were recorded. Survival was 54.9%. Bleeding occurred in 70.2%, including intracranial hemorrhage in 16%, and was independently associated with higher daily risk of mortality. Circuit component changes were required in 31.1%, and patient-related clots occurred in 12.8%. Laboratory sampling contributed to transfusion requirement in 56.6%, and was the sole reason for at least one transfusion in 42.2% of patients. Pump type was not associated with bleeding, thrombosis, hemolysis, or mortality. Hemolysis was predictive of subsequent thrombotic events. Neither hemolysis nor thrombotic events increased the risk of mortality. Conclusions: The incidences of bleeding and thrombosis are high during ECMO support. Laboratory sampling is a major contributor to transfusion during ECMO. Strategies to reduce the daily risk of bleeding and thrombosis, and different thresholds for transfusion, may be appropriate subjects of future trials to improve outcomes of children requiring this supportive therapy.
AB - Rationale: Extracorporeal membrane oxygenation (ECMO) is used for respiratory and cardiac failure in children but is complicated by bleeding and thrombosis. Objectives: (1) To measure the incidence of bleeding (blood loss requiring transfusion or intracranial hemorrhage) and thrombosis during ECMO support; (2) to identify factors associated with these complications; and (3) to determine the impact of these complications on patient outcome. Methods: This was a prospective, observational cohort study in pediatric, cardiac, and neonatal intensive care units in eight hospitals, carried out from December 2012 to September 2014. Measurements and Main Results: ECMO was used on 514 consecutive patients under age 19 years. Demographics, anticoagulation practices, severity of illness, circuitry components, bleeding, thrombotic events, and outcome were recorded. Survival was 54.9%. Bleeding occurred in 70.2%, including intracranial hemorrhage in 16%, and was independently associated with higher daily risk of mortality. Circuit component changes were required in 31.1%, and patient-related clots occurred in 12.8%. Laboratory sampling contributed to transfusion requirement in 56.6%, and was the sole reason for at least one transfusion in 42.2% of patients. Pump type was not associated with bleeding, thrombosis, hemolysis, or mortality. Hemolysis was predictive of subsequent thrombotic events. Neither hemolysis nor thrombotic events increased the risk of mortality. Conclusions: The incidences of bleeding and thrombosis are high during ECMO support. Laboratory sampling is a major contributor to transfusion during ECMO. Strategies to reduce the daily risk of bleeding and thrombosis, and different thresholds for transfusion, may be appropriate subjects of future trials to improve outcomes of children requiring this supportive therapy.
KW - Cardiorespiratory failure
KW - Extracorporeal life support
KW - Hemolysis
KW - Outcome
KW - Transfusion
UR - http://www.scopus.com/inward/record.url?scp=85029670756&partnerID=8YFLogxK
U2 - 10.1164/rccm.201609-1945OC
DO - 10.1164/rccm.201609-1945OC
M3 - Article
C2 - 28328243
AN - SCOPUS:85029670756
SN - 1073-449X
VL - 196
SP - 762
EP - 771
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 6
ER -