Document Detail

Hematological abnormalities in neonatal patients treated with extracorporeal membrane oxygenation (ECMO).
MedLine Citation:
PMID:  10182118     Owner:  NLM     Status:  MEDLINE    
The physical process of extracorporeal membrane oxygenation (ECMO) results in derangement of the hemostatic mechanism, which may lead to increased morbidity, secondary to the disease process. The purpose of this study was to evaluate the hematological status of neonates undergoing ECMO therapy, and to evaluate coagulation tests in predicting hemorrhagic risk. Following Institutional Review Board approval, 30 patients undergoing ECMO treatment were retrospectively entered into this study. Medical records were reviewed and indicators of hemostasis, transfusion, morbidity, and outcomes recorded. Assessment of coagulation was determined through serial analysis of platelet count, fibrinogen concentration, prothrombin time (PT), activated partial thromboplastin time (aPTT), antithrombin III, fibrin split products, D-dimers, plasma free hemoglobin, activated clotting time, ionized calcium, and thrombelastography (TEG). Median total transfusion requirements for all patients were 1.79 ml/kg/ECMO hr. Fifty-seven percent of the 30 patients were diagnosed as coagulopathic according to Extracorporeal Life Support Organization standards. Patients were separated into either a hemorrhagic group (HEM, > 2.0 ml/kg/ECMO hr, n = 13) or a nonhemorrhagic group (N-HEM, n = 17), with HEM patients requiring twice the transfusion volume of N-HEM (p < 0.0001). Hemorrhagic complications were reported in 53.8% of the HEM patients vs. 35.3% in the N-HEM group. HEM patients were transfused with significantly greater quantities of platelets on days 1, 3, 5, and 8 and packed red blood cells on day 7 when compared to N-HEM (p < 0.05). TEG determination showed significant differences between groups on days 3 and 6 (p < 0.005), and 8 (p < 0.05). Derangements in hemostasis resulting from ECMO are profound, with methods of assessing coagulation complicated by both the variability in patient condition and lack of specificity of laboratory tests. Interpretation of TEG data has shown to be a valuable supplement for managing this challenging patient population.
D P Zavadil; A H Stammers; L D Willett; J J Deptula; K A Christensen; R T Sydzyik
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of extra-corporeal technology     Volume:  30     ISSN:  0022-1058     ISO Abbreviation:  J Extra Corpor Technol     Publication Date:  1998 Jun 
Date Detail:
Created Date:  1998-09-14     Completed Date:  1998-09-14     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0267637     Medline TA:  J Extra Corpor Technol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  83-90     Citation Subset:  T    
Division of Clinical Perfusion Education, University of Nebraska Medical Center, Omaha, USA.
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MeSH Terms
Antifibrinolytic Agents / blood
Antithrombin III / analysis
Antithrombins / analysis
Blood Coagulation / physiology
Blood Transfusion
Calcium / blood
Erythrocyte Transfusion
Extracorporeal Membrane Oxygenation* / adverse effects
Fibrin Fibrinogen Degradation Products / analysis
Fibrinogen / analysis
Hemoglobins / analysis
Hemorrhage / etiology
Hemostasis / physiology*
Infant, Newborn
Partial Thromboplastin Time
Platelet Count
Platelet Transfusion
Prothrombin Time
Retrospective Studies
Serine Proteinase Inhibitors / blood
Treatment Outcome
Whole Blood Coagulation Time
Reg. No./Substance:
0/Antifibrinolytic Agents; 0/Antithrombins; 0/Fibrin Fibrinogen Degradation Products; 0/Hemoglobins; 0/Serine Proteinase Inhibitors; 0/fibrin fragment D; 7440-70-2/Calcium; 9000-94-6/Antithrombin III; 9001-32-5/Fibrinogen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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