Research and Practice in Thrombosis and Haemostasis (Jul 2021)

Use of rotational thromboelastometry to predict hemostatic complications in pediatric patients undergoing extracorporeal membrane oxygenation: A retrospective cohort study

  • Joppe G. Drop,
  • Özge Erdem,
  • Enno D. Wildschut,
  • Joost vanRosmalen,
  • Moniek P. M. deMaat,
  • Jan‐Willem Kuiper,
  • Robert Jan M. Houmes,
  • C. Heleen vanOmmen

DOI
https://doi.org/10.1002/rth2.12553
Journal volume & issue
Vol. 5, no. 5
pp. n/a – n/a

Abstract

Read online

Abstract Background The incidence of hemostatic complications in pediatric patients undergoing extracorporeal membrane oxygenation (ECMO) is high. The optimal anticoagulation strategy in children undergoing ECMO is unknown. Objectives To study the association between hemostatic complications, coagulation tests, and clinical parameters in pediatric patients undergoing ECMO and their effect on survival. Methods We performed a retrospective cohort study of pediatric patients undergoing centrifugal pump ECMO. Collected data included patient characteristics, risk factors, and coagulation test results. Statistical analysis was done using logistic regression analysis for repeated measurements. Dependent variables were thrombosis and bleeding, independent variables were rotational thromboelastometry (ROTEM), activated partial thromboplastin time (aPTT) and antifactor‐Xa assay (aXa) results, ECMO duration, age <29 days, sepsis and surgery. Results Seventy‐three patients with 623 ECMO days were included. Cumulative incidences of thrombosis and bleeding were 43.5% (95% confidence interval [CI], 26.0%‐59.8%) and 25.4% (95% CI, 13.4%‐39.3%), respectively. A lower maximum clot firmness of intrinsic ROTEM (INTEM; odds ratio [OR], 0.946; 95% CI, 0.920‐0.969), extrinsic ROTEM (OR, 0.945; 95% CI, 0.912‐0.973), and INTEM with heparinase (OR, 0.936; 95% CI, 0.896‐0.968); higher activated partial thromboplastin time aPTT; OR, 1.020; 95% CI, 1.006‐1.024) and age <29 days (OR, 2.900; 95% CI, 1.282‐6.694); surgery (OR, 4.426; 95% CI, 1.543‐12.694); and longer ECMO duration (OR, 1.149; 95% CI, 1.022‐1.292) significantly increased thrombotic risk. Surgery (OR, 2.698; 95% CI, 1.543‐12.694) and age <29 days (OR 2.242, 95% CI 1.282–6.694) were significantly associated with major bleeding. Patients with hemostatic complications had significantly decreased survival to hospital discharge (P = .009). Conclusion The results of this study help elucidate the role of ROTEM, aPTT, anti–factor Xa, and clinical risk factors in predicting hemostatic complications in pediatric patients undergoing ECMO.

Keywords