Factors associated with bleeding and thrombosis in children receiving extracorporeal membrane oxygenation

Heidi J. Dalton*, Ron Reeder, Pamela Garcia-Filion, Richard Holubkov, Robert A. Berg, Athena Zuppa, Frank W. Moler, Thomas Shanley, Murray Pollack, Christopher Newth, John Berger, David Wessel, Joseph Carcillo, Michael Bell, Sabrina Heidemann, Kathleen L. Meert, Richard Harrison, Allan Doctor, Robert F. Tamburro, J. Michael DeanTammara Jenkins, Carol Nicholson

*Corresponding author for this work

Research output: Contribution to journalArticle

63 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)762-771
Number of pages10
JournalAmerican journal of respiratory and critical care medicine
Volume196
Issue number6
DOIs
StatePublished - Sep 15 2017

Keywords

  • Cardiorespiratory failure
  • Extracorporeal life support
  • Hemolysis
  • Outcome
  • Transfusion

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Factors associated with bleeding and thrombosis in children receiving extracorporeal membrane oxygenation'. Together they form a unique fingerprint.

  • Cite this

    Dalton, H. J., Reeder, R., Garcia-Filion, P., Holubkov, R., Berg, R. A., Zuppa, A., Moler, F. W., Shanley, T., Pollack, M., Newth, C., Berger, J., Wessel, D., Carcillo, J., Bell, M., Heidemann, S., Meert, K. L., Harrison, R., Doctor, A., Tamburro, R. F., ... Nicholson, C. (2017). Factors associated with bleeding and thrombosis in children receiving extracorporeal membrane oxygenation. American journal of respiratory and critical care medicine, 196(6), 762-771. https://doi.org/10.1164/rccm.201609-1945OC