Document Detail


Variability in anticoagulation management of patients on extracorporeal membrane oxygenation: an international survey.
MedLine Citation:
PMID:  23287906     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The objective of this study was to determine current practices of anticoagulation in patients on extracorporeal membrane oxygenation.
DESIGN: Internet-based cross-sectional survey distributed between November 2010 and May 2011.
SETTING: Extracorporeal Life Support Organization-registered extracorporeal membrane oxygenation centers internationally.
PARTICIPANTS: : Extracorporeal membrane oxy genation medical directors and coordinators.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: There were 121 responses from extracorporeal membrane oxy genation medical directors and coordinators at 187 Extracorporeal Life Support Organization centers with access to the survey. Eighty-four of 117 (72%) respondents reported having a written institutional extracorporeal membrane oxy genation protocol for both anticoagulation and blood product management at their institutions. Sixty-nine of 117 (59%) respondents reported use of tip-to-tip or partially heparin-bonded circuits. Unfractionated heparin was used at all centers; only 8% of respondents indicated use of alternative anticoagulation medications in the six months prior to the survey. The preferred method of anticoagulation monitoring was the serial measurement of activated clotting time, as reported by 97% of respondents. In this survey, 82% of respondents reported antithrombin III testing, 65% reported anti-factor Xa testing, and 43% reported use of thromboelastography during extracorporeal membrane oxy genation. Goal ranges for these three tests and interventions triggered by out-of-range values were found to be variable.
CONCLUSIONS: Extracorporeal membrane oxy genation anticoagulation management policies vary widely by center. The majority of extracorporeal membrane oxy genation programs employ activated clotting time as the preferred anticoagulation monitoring tool. The coagulation system is also monitored using more specific markers such as antithrombin III, anti-factor Xa, and thromboelastography by a large number of centers. Future research is needed to elucidate optimal anticoagulation management and improve outcomes.
Authors:
Melania M Bembea; Gail Annich; Peter Rycus; Gary Oldenburg; Ivor Berkowitz; Peter Pronovost
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  14     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-07     Completed Date:  2013-09-16     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e77-84     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / administration & dosage*
Antithrombin III / metabolism
Cross-Sectional Studies
Extracorporeal Membrane Oxygenation / methods*
Heparin / administration & dosage
Hospital Units*
Humans
Physician's Practice Patterns*
Policy
Practice Guidelines as Topic
Questionnaires
Thrombelastography
Grant Support
ID/Acronym/Agency:
1KL2RR025006-01/RR/NCRR NIH HHS; KL2 RR025006/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Anticoagulants; 9000-94-6/Antithrombin III; 9005-49-6/Heparin
Comments/Corrections
Comment In:
Pediatr Crit Care Med. 2013 Feb;14(2):231-3   [PMID:  23388574 ]

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


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