Pediatr Surg Int. 2020 Jun 30. doi: 10.1007/s00383-020-04694-0. [Epub ahead of print] https://pmlegacy.ncbi.nlm.nih.gov/pubmed/32607833
Thromboelastography-guided management of coagulopathy in neonates with congenital diaphragmatic hernia supported by extracorporeal membrane oxygenation.
Phillips RC1, Shahi N2, Leopold D2, Levek C3,4, Shirek G2, Hilton S2, Hyslop R5, Gien J6, Kinsella JP6, Buckvold S5, Liechty KW2,4, Kim JS5, Marwan AI2,4.
Congenital diaphragmatic hernia (CDH) can cause severe hemodynamic deterioration requiring support with extracorporeal membrane oxygenation (ECMO). ECMO is associated with hemorrhagic and thromboembolic complications. In 2015, we standardized anti-coagulation management on ECMO, incorporating thromboelastography (TEG) as an adjunct to manage hemostasis of CDH patients. The purpose of this study is to evaluate our blood product utilization, choice of blood product use in response to abnormal TEG parameters, and the associated effect on bleeding and thrombotic complications.
We retrospectively reviewed all CDH neonates supported by ECMO between 2008 and 2018. Blood product administration, TEG data, and hemorrhagic and thrombotic complications data were collected. We divided subjects into two groups pre-2015 and post-2015.
After 2015, platelet transfusion was administered for a low maximum amplitude (MA) more frequently (77% compared to 65%, p = 0.0007). Cryoprecipitate was administered less frequently for a low alpha-angle (28% compared to 41%, p = 0.0016). There was no difference in fresh frozen plasma use over time. After standardizing the use of TEG, we observed a significant reduction in hemothoraces (18% compared to 54%, p = 0.026).
Institutional standardization of anti-coagulation management of CDH neonates on ECMO, including the use of goal-directed TEG monitoring may lead to improved blood product utilization and a decrease in bleeding complications in neonates with CDH supported by ECMO.
LEVEL OF EVIDENCE/TYPE OF STUDY:
Level III, Retrospective comparative study.
Coagulation; Congenital diaphragmatic hernia; Extracorporeal membrane oxygenation; Hemorrhage; NeonatalPMID: 32607833 DOI: 10.1007/s00383-020-04694-0