PB1014 - Thromboelastography Characteristics in Pediatric Patients on Extracorporeal Membrane Oxygenation (ECMO)

Background: Extracorporeal membrane oxygenation (ECMO) can be lifesaving for critically ill patients of all ages. Balancing the risk of bleeding and thrombosis is challenging in pediatric patients and limited by our current anticoagulation and monitoring strategies. Novel monitoring of thrombin generation may be a key marker for these hemostatic complications and may be influenced by inflammation.

Aims: The aims of this study were to evaluate whether novel laboratory tests are better able to predict patients at risk for hemostatic complications compared to routine laboratory tests. We hypothesized that ECMO related thrombosis would be associated with increased thrombin generation and ECMO related bleeding would be associated with decreased thrombin generation.

Methods: An IRB approved prospective pilot study of patients requiring ECMO was conducted at Children’s Hospital of Michigan. Patients were enrolled within 24 hours of ECMO cannulation after informed consent. Patients aged 0-17 years placed on venoarterial (VA) or venovenous (VV) ECMO were included. Included is the preliminary data of the first 32 patients enrolled.

Results: Table 1 shows demographic data for the cohort. The 32 patients had a total of 243 ECMO days. Subgroup analyses were performed for patients based on days of bleeding/thrombotic complications. Categories included “no event” (N=174), “bleeding event” (N=26) and “clotting event” (N=43). Bleeding events had significantly decreased hemoglobin and fibrinogen levels and prolonged prothrombin time compared to no event and clotting events. Laboratory data for thromboelastography (TEG®) is shown in table 2.

Conclusion(s): Bleeding events on ECMO are associated with increased mortality. Our findings suggest that lower fibrinogen levels, prolonged PT and decreased thrombin generation (as assessed by the TEG) are associated with an increased risk for major bleeding. Thrombin generation assay statistical analysis is pending. The results illustrate the challenges in monitoring ECMO anticoagulation and additional study of novel tests are needed to identify and avoid clinical complications.