Risk Factors Associated With Bleeding in Children With Cardiac Disease Receiving Extracorporeal Membrane Oxygenation: A Multi-Center Data Linkage Analysis
Background: Bleeding is a common complication of extracorporeal membrane oxygenation (ECMO) for pediatric cardiac patients. We aimed to identify anticoagulation practices, cardiac diagnoses, and surgical variables associated with bleeding during pediatric cardiac ECMO by combining two established da...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-01-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2021.812881/full |
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| author | Ashish A. Ankola David K. Bailly Ron W. Reeder Katherine Cashen Heidi J. Dalton Stephen J. Dolgner Myke Federman Rod Ghassemzadeh Adam S. Himebauch Asavari Kamerkar Josh Koch Joseph Kohne Margaret Lewen Neeraj Srivastava Renee Willett Peta M. A. Alexander Peta M. A. Alexander |
| author_facet | Ashish A. Ankola David K. Bailly Ron W. Reeder Katherine Cashen Heidi J. Dalton Stephen J. Dolgner Myke Federman Rod Ghassemzadeh Adam S. Himebauch Asavari Kamerkar Josh Koch Joseph Kohne Margaret Lewen Neeraj Srivastava Renee Willett Peta M. A. Alexander Peta M. A. Alexander |
| author_sort | Ashish A. Ankola |
| collection | DOAJ |
| description | Background: Bleeding is a common complication of extracorporeal membrane oxygenation (ECMO) for pediatric cardiac patients. We aimed to identify anticoagulation practices, cardiac diagnoses, and surgical variables associated with bleeding during pediatric cardiac ECMO by combining two established databases, the Collaborative Pediatric Critical Care Research Network (CPCCRN) Bleeding and Thrombosis in ECMO (BATE) and the Extracorporeal Life Support Organization (ELSO) Registry.Methods: All children (<19 years) with a primary cardiac diagnosis managed on ECMO included in BATE from six centers were analyzed. ELSO Registry criteria for bleeding events included pulmonary or intracranial bleeding, or red blood cell transfusion >80 ml/kg on any ECMO day. Bleeding odds were assessed on ECMO Day 1 and from ECMO Day 2 onwards with multivariable logistic regression.Results: There were 187 children with 114 (61%) bleeding events in the study cohort. Biventricular congenital heart disease (94/187, 50%) and cardiac medical diagnoses (75/187, 40%) were most common, and 48 (26%) patients were cannulated directly from cardiopulmonary bypass (CPB). Bleeding events were not associated with achieving pre-specified therapeutic ranges of activated clotting time (ACT) or platelet levels. In multivariable analysis, elevated INR and fibrinogen were associated with bleeding events (OR 1.1, CI 1.0–1.3, p = 0.02; OR 0.77, CI 0.6–0.9, p = 0.004). Bleeding events were also associated with clinical site (OR 4.8, CI 2.0–11.1, p < 0.001) and central cannulation (OR 1.75, CI 1.0–3.1, p = 0.05) but not with cardiac diagnosis, surgical complexity, or cannulation from CPB. Bleeding odds on ECMO day 1 were increased in patients with central cannulation (OR 2.82, 95% CI 1.15–7.08, p = 0.023) and those cannulated directly from CPB (OR 3.32, 95% CI 1.02–11.61, p = 0.047).Conclusions: Bleeding events in children with cardiac diagnoses supported on ECMO were associated with central cannulation strategy and coagulopathy, but were not modulated by achieving pre-specified therapeutic ranges of monitoring assays. |
| first_indexed | 2024-04-11T16:52:31Z |
| format | Article |
| id | doaj.art-b334fe5e2d3d44c0b075f5369b7f4279 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-11T16:52:31Z |
| publishDate | 2022-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-b334fe5e2d3d44c0b075f5369b7f42792022-12-22T04:13:24ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-01-01810.3389/fcvm.2021.812881812881Risk Factors Associated With Bleeding in Children With Cardiac Disease Receiving Extracorporeal Membrane Oxygenation: A Multi-Center Data Linkage AnalysisAshish A. Ankola0David K. Bailly1Ron W. Reeder2Katherine Cashen3Heidi J. Dalton4Stephen J. Dolgner5Myke Federman6Rod Ghassemzadeh7Adam S. Himebauch8Asavari Kamerkar9Josh Koch10Joseph Kohne11Margaret Lewen12Neeraj Srivastava13Renee Willett14Peta M. A. Alexander15Peta M. A. Alexander16Department of Pediatrics, Divisions of Critical Care and Cardiology, Baylor College of Medicine, Houston, TX, United StatesDepartment of Pediatrics, Division of Pediatric Critical Care, University of Utah, Salt Lake City, UT, United StatesDepartment of Pediatrics, University of Utah, Salt Lake City, UT, United StatesDepartment of Pediatrics, Children's Hospital of Michigan, Detroit, MI, United StatesDepartment of Pediatrics and Heart and Vascular Institute, Inova Fairfax Hospital, Fall Church, VA, United StatesDepartment of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, TX, United StatesDepartment of Pediatrics, Mattel Children's Hospital UCLA, Los Angeles, CA, United StatesDepartment of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA, United StatesDepartment of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, United States0Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States1Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ, United States2Department of Pediatrics, University of Michigan, Ann Arbor, MI, United StatesDepartment of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA, United StatesDepartment of Pediatrics, Mattel Children's Hospital UCLA, Los Angeles, CA, United States3Department of Pediatrics, Children's National Hospital, Washington, DC, United States4Department of Cardiology, Boston Children's Hospital, Boston, MA, United States5Department of Pediatrics and Harvard Medical School, Boston, MA, United StatesBackground: Bleeding is a common complication of extracorporeal membrane oxygenation (ECMO) for pediatric cardiac patients. We aimed to identify anticoagulation practices, cardiac diagnoses, and surgical variables associated with bleeding during pediatric cardiac ECMO by combining two established databases, the Collaborative Pediatric Critical Care Research Network (CPCCRN) Bleeding and Thrombosis in ECMO (BATE) and the Extracorporeal Life Support Organization (ELSO) Registry.Methods: All children (<19 years) with a primary cardiac diagnosis managed on ECMO included in BATE from six centers were analyzed. ELSO Registry criteria for bleeding events included pulmonary or intracranial bleeding, or red blood cell transfusion >80 ml/kg on any ECMO day. Bleeding odds were assessed on ECMO Day 1 and from ECMO Day 2 onwards with multivariable logistic regression.Results: There were 187 children with 114 (61%) bleeding events in the study cohort. Biventricular congenital heart disease (94/187, 50%) and cardiac medical diagnoses (75/187, 40%) were most common, and 48 (26%) patients were cannulated directly from cardiopulmonary bypass (CPB). Bleeding events were not associated with achieving pre-specified therapeutic ranges of activated clotting time (ACT) or platelet levels. In multivariable analysis, elevated INR and fibrinogen were associated with bleeding events (OR 1.1, CI 1.0–1.3, p = 0.02; OR 0.77, CI 0.6–0.9, p = 0.004). Bleeding events were also associated with clinical site (OR 4.8, CI 2.0–11.1, p < 0.001) and central cannulation (OR 1.75, CI 1.0–3.1, p = 0.05) but not with cardiac diagnosis, surgical complexity, or cannulation from CPB. Bleeding odds on ECMO day 1 were increased in patients with central cannulation (OR 2.82, 95% CI 1.15–7.08, p = 0.023) and those cannulated directly from CPB (OR 3.32, 95% CI 1.02–11.61, p = 0.047).Conclusions: Bleeding events in children with cardiac diagnoses supported on ECMO were associated with central cannulation strategy and coagulopathy, but were not modulated by achieving pre-specified therapeutic ranges of monitoring assays.https://www.frontiersin.org/articles/10.3389/fcvm.2021.812881/fullextracorporeal membrane oxygenationbleedingpediatriccardiacanticoagulation |
| spellingShingle | Ashish A. Ankola David K. Bailly Ron W. Reeder Katherine Cashen Heidi J. Dalton Stephen J. Dolgner Myke Federman Rod Ghassemzadeh Adam S. Himebauch Asavari Kamerkar Josh Koch Joseph Kohne Margaret Lewen Neeraj Srivastava Renee Willett Peta M. A. Alexander Peta M. A. Alexander Risk Factors Associated With Bleeding in Children With Cardiac Disease Receiving Extracorporeal Membrane Oxygenation: A Multi-Center Data Linkage Analysis Frontiers in Cardiovascular Medicine extracorporeal membrane oxygenation bleeding pediatric cardiac anticoagulation |
| title | Risk Factors Associated With Bleeding in Children With Cardiac Disease Receiving Extracorporeal Membrane Oxygenation: A Multi-Center Data Linkage Analysis |
| title_full | Risk Factors Associated With Bleeding in Children With Cardiac Disease Receiving Extracorporeal Membrane Oxygenation: A Multi-Center Data Linkage Analysis |
| title_fullStr | Risk Factors Associated With Bleeding in Children With Cardiac Disease Receiving Extracorporeal Membrane Oxygenation: A Multi-Center Data Linkage Analysis |
| title_full_unstemmed | Risk Factors Associated With Bleeding in Children With Cardiac Disease Receiving Extracorporeal Membrane Oxygenation: A Multi-Center Data Linkage Analysis |
| title_short | Risk Factors Associated With Bleeding in Children With Cardiac Disease Receiving Extracorporeal Membrane Oxygenation: A Multi-Center Data Linkage Analysis |
| title_sort | risk factors associated with bleeding in children with cardiac disease receiving extracorporeal membrane oxygenation a multi center data linkage analysis |
| topic | extracorporeal membrane oxygenation bleeding pediatric cardiac anticoagulation |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2021.812881/full |
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