Critical Care
Critical Care 2
Noel Joseph, MD
Fellow
Le Bonheur Children's Hospital
Memphis, Tennessee, United States
Extracorporeal membrane oxygenation (ECMO) offers a final therapeutic option for children with respiratory and/or cardiac failure. One of the challenges when treating patients on ECMO is maintaining optimal anticoagulation, where inadequate anticoagulation can lead to thrombosis formation and circuit clotting, or bleeding. Heparin is routinely used for its cost-effectiveness and familiarity amongst providers. However, the use of direct thrombin inhibitors such Bivalirudin (Bival) is growing in popularity due to its physiologic advantages specifically in the pediatric population. At our institution, the use of bivalirudin is reserved for patients with heparin-induced thrombocytopenia, heparin resistance, or specific patient populations. Current studies comparing the use of heparin vs bivalirudin are largely retrospective with the need for prospective data.
Objective: To assess frequency of complications on ECMO when on Heparin vs Bival
Design/Methods:
We have conducted a retrospective, observational study to describe safety during the use of either heparin or bivalirudin (bival) during ECMO from 2019-2022. Data was collected from Cerner electronic medical record. Administration of heparin or bival as per hospital guidelines and clinician preference. ECMO parameters included the number of hours on ECMO and complications (mechanical, thrombotic/hemorrhagic, neurologic, pulmonary, renal, and metabolic). Descriptive statistics were completed using SPSS.
Results:
Of 125 patients with information collected from 2019 to 2022, 43.2% were under the age of 1 year, 58.4% were male, and 53.6% were identified as Black/African American. Median hours on ECMO were 129.0 (IQR 64.00-234.50). The majority of patients received ECMO in the PICU (60.5%). Of 125 patients, 107 had anticoagulation status recorded, with an overall preference of heparin use amongst providers (64.0%). There was a difference between heparin and bival use in PICU and CVICU with no preference of bival over heparin in CVICU. About 64% of patients who received bival did not have complications during the ECMO run compared to 43.8% of patients who received heparin. Of patients who had multiple complications(n=14), 3 (21.4%) received bival when compared to those who received heparin (78.6%). About 72.7% of patients who received bival during their ECMO run were discharged alive in comparison to 58.8% of patients who received heparin.
Conclusion(s):
Our descriptive study demonstrated that pediatric patients who receive bival during pediatric ECMO have a superior safety profile than those who receive heparin.