Epidemiology of the Use of Hemostatic Agents in Children Supported by Extracorporeal Membrane Oxygenation: A Pediatric Health Information System Database Study
Objectives: Children supported by extracorporeal membrane oxygenation (ECMO) are at high risk of bleeding. Though practitioners often prescribe blood components and/or medications to prevent or treat bleeding, the utilization of these hemostatic measures in children is not well-understood. We sought...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-05-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2021.673613/full |
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| author | Marianne E. Nellis Ljiljana V. Vasovic Ruchika Goel Ruchika Goel Oliver Karam |
| author_facet | Marianne E. Nellis Ljiljana V. Vasovic Ruchika Goel Ruchika Goel Oliver Karam |
| author_sort | Marianne E. Nellis |
| collection | DOAJ |
| description | Objectives: Children supported by extracorporeal membrane oxygenation (ECMO) are at high risk of bleeding. Though practitioners often prescribe blood components and/or medications to prevent or treat bleeding, the utilization of these hemostatic measures in children is not well-understood. We sought to evaluate the use of hemostatic blood products (platelet, plasma and cryoprecipitate transfusions) and medications [aminocaproic acid, tranexamic acid (TXA) and Factor VIIa] in children supported by ECMO.Design: Retrospective observational study using the Pediatric Health Information System (PHIS) database from 2011-2017.Setting: Fifty-one U.S. children's hospitals.Patients: Children (aged 0–18 years) supported by ECMO.Interventions: None.Measurements and Main Results: ECMO was employed in the care of 7,910 children for a total of 56,079 ECMO days. Fifty-five percent of the patients were male with a median (IQR) age of 0 (0–2) years. The median (IQR) length of ECMO was 5 (2–9) days with a hospital mortality rate of 34%. Platelets were transfused on 49% of ECMO days, plasma on 33% of ECMO days and cryoprecipitate on 17% of ECMO days. Twenty-two percent of children received TXA with the majority receiving it on the first day of ECMO and the use of TXA increased during the 6-year period studied (p < 0.001). Seven percent of children received aminocaproic acid and 3% received Factor VIIa.Conclusions: Children supported by ECMO are exposed to a significant number of hemostatic blood products. Antifibrinolytics, in particular TXA, are being used more frequently. Given the known morbidity and mortality associated with hemostatic blood products, studies are warranted to evaluate the effectiveness of hemostatic strategies. |
| first_indexed | 2024-12-18T00:35:18Z |
| format | Article |
| id | doaj.art-36ee515db3754aeba5ea971b2ead42fc |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-18T00:35:18Z |
| publishDate | 2021-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-36ee515db3754aeba5ea971b2ead42fc2022-12-21T21:27:01ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602021-05-01910.3389/fped.2021.673613673613Epidemiology of the Use of Hemostatic Agents in Children Supported by Extracorporeal Membrane Oxygenation: A Pediatric Health Information System Database StudyMarianne E. Nellis0Ljiljana V. Vasovic1Ruchika Goel2Ruchika Goel3Oliver Karam4Department of Pediatrics, New York Presbyterian Hospital – Weill Cornell Medicine, New York, NY, United StatesDepartment of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United StatesDivision of Hematology, Oncology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United StatesDivision of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, MD, United StatesDivision of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, United StatesObjectives: Children supported by extracorporeal membrane oxygenation (ECMO) are at high risk of bleeding. Though practitioners often prescribe blood components and/or medications to prevent or treat bleeding, the utilization of these hemostatic measures in children is not well-understood. We sought to evaluate the use of hemostatic blood products (platelet, plasma and cryoprecipitate transfusions) and medications [aminocaproic acid, tranexamic acid (TXA) and Factor VIIa] in children supported by ECMO.Design: Retrospective observational study using the Pediatric Health Information System (PHIS) database from 2011-2017.Setting: Fifty-one U.S. children's hospitals.Patients: Children (aged 0–18 years) supported by ECMO.Interventions: None.Measurements and Main Results: ECMO was employed in the care of 7,910 children for a total of 56,079 ECMO days. Fifty-five percent of the patients were male with a median (IQR) age of 0 (0–2) years. The median (IQR) length of ECMO was 5 (2–9) days with a hospital mortality rate of 34%. Platelets were transfused on 49% of ECMO days, plasma on 33% of ECMO days and cryoprecipitate on 17% of ECMO days. Twenty-two percent of children received TXA with the majority receiving it on the first day of ECMO and the use of TXA increased during the 6-year period studied (p < 0.001). Seven percent of children received aminocaproic acid and 3% received Factor VIIa.Conclusions: Children supported by ECMO are exposed to a significant number of hemostatic blood products. Antifibrinolytics, in particular TXA, are being used more frequently. Given the known morbidity and mortality associated with hemostatic blood products, studies are warranted to evaluate the effectiveness of hemostatic strategies.https://www.frontiersin.org/articles/10.3389/fped.2021.673613/fullextracorporeal membrane oxygenationplatelet transfusionplasmaantifibrinolytic therapycritical illnesschildren |
| spellingShingle | Marianne E. Nellis Ljiljana V. Vasovic Ruchika Goel Ruchika Goel Oliver Karam Epidemiology of the Use of Hemostatic Agents in Children Supported by Extracorporeal Membrane Oxygenation: A Pediatric Health Information System Database Study Frontiers in Pediatrics extracorporeal membrane oxygenation platelet transfusion plasma antifibrinolytic therapy critical illness children |
| title | Epidemiology of the Use of Hemostatic Agents in Children Supported by Extracorporeal Membrane Oxygenation: A Pediatric Health Information System Database Study |
| title_full | Epidemiology of the Use of Hemostatic Agents in Children Supported by Extracorporeal Membrane Oxygenation: A Pediatric Health Information System Database Study |
| title_fullStr | Epidemiology of the Use of Hemostatic Agents in Children Supported by Extracorporeal Membrane Oxygenation: A Pediatric Health Information System Database Study |
| title_full_unstemmed | Epidemiology of the Use of Hemostatic Agents in Children Supported by Extracorporeal Membrane Oxygenation: A Pediatric Health Information System Database Study |
| title_short | Epidemiology of the Use of Hemostatic Agents in Children Supported by Extracorporeal Membrane Oxygenation: A Pediatric Health Information System Database Study |
| title_sort | epidemiology of the use of hemostatic agents in children supported by extracorporeal membrane oxygenation a pediatric health information system database study |
| topic | extracorporeal membrane oxygenation platelet transfusion plasma antifibrinolytic therapy critical illness children |
| url | https://www.frontiersin.org/articles/10.3389/fped.2021.673613/full |
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