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Coagulation Profile Is Not a Predictor of Acute Cerebrovascular Events in Pediatric Extracorporeal Membrane Oxygenation Patients

Anton-Martin, Pilar*; Journeycake, Janna; Modem, Vinai; Golla, Sailaja§; Raman, Lakshmi*; Tweed, Jefferson; Darnell-Bowens, Cindy*

doi: 10.1097/MAT.0000000000000571
Pediatric Circulatory Support

We performed a retrospective matched case–control study evaluating whether the traditional coagulation profile predicts cerebrovascular events in children on extracorporeal membrane oxygenation (ECMO) in a 71 bed intensive care unit at a tertiary children’s hospital. Between 2009 and 2014, 241 neonates and children were initiated on ECMO. The cumulative 5 year incidence of intracranial hemorrhage and infarct was 9.2% and 7.9%, respectively. Thirty-six cases were individually matched 1:1 with control subjects based on age, primary diagnosis, ECMO type, cannulation site, and the presence of pre-ECMO coagulopathy. In-hospital mortality was higher among the cases compared with control subjects (78 vs. 22%, p < 0.01). The median laboratory values that assisted with heparin anticoagulation monitoring (activated clotting time, partial thromboplastin time, and antifactor Xa) and the laboratory data that assisted with blood product administration (platelet count, prothrombin time, fibrinogen, and d-dimer) during the 24 and 72 hour periods before the cerebrovascular event did not show any significant difference between the hemorrhage group and their controls or between the infarct group and their controls. The traditional coagulation profile did not predict acute cerebrovascular events in our cohort. Other markers of neurologic injury on ECMO are yet to be elucidated. Prospective studies to determine better predictors of cerebrovascular complications in pediatric ECMO patients are required.

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From the *Department of Pediatrics, Critical Care Division, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Pediatrics, Hematology-Oncology Division, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Pediatrics, Critical Care Division, University of Texas Health Science Center at Houston, Houston, Texas; §Department of Pediatrics, Neurology Division, University of Texas Southwestern Medical Center, Dallas, Texas; and Trauma Services Children’s Health Dallas, Dallas, Texas.

Submitted for consideration September 2016; accepted for publication in revised form March 2017.

Disclosure: The authors have disclosed that they do not have any conflicts of interest and there is no source of funding.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Pilar Anton-Martin, Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern/Children’s Health Dallas, 1935 Medical District Drive, Dallas, TX 75235. E-mail: pilarantonmartin@gmail.com.

Copyright © 2017 by the American Society for Artificial Internal Organs