Anticoagulation and pediatric extracorporeal life support (ECLS). A review of current practice and recommendations

Abstract

Pediatric ECLS and advances in ECMO management have truly evolved as a critical management strategy with improved outcomes and holistic survival over the last two decades. Excessive bleeding and thrombosis still constitute the principal cause of morbidity and mortality. The non-biological surface of an extracorporeal circuit provokes a massive inflammatory response initiating consumption and activation of procoagulant and anticoagulant components. Besides the vast difference in neonatal and adult coagulation and transfusion requirements, render anticoagulation on ECMO as a major determinant in reducing morbidity. Anticoagulation is a fluid science and it is imperative that caregivers are aware of the existing anticoagulants with their advantages and disadvantages and advances in monitoring tools to ensure that morbidity is minimized with better outcomes.

Keywords

• anticoagulation
• extracorporeal membrane oxygenation
• bleeding
• thrombosis