(522) Monitoring of Coagulopathy in Pediatric Patients Supported With Extracorporeal Membrane Oxygenation

Introduction: Bleeding and clotting are known complications in pediatric patients receiving extracorporeal membrane oxygenation (ECMO). Hemostatic monitoring is an avenue to assess the likelihood of these complications. This study aims to (i) describe bleeding and thrombotic outcomes in pediatric patients receiving ECMO and (ii) compare the results of conventional coagulation testing to viscoelastic hemostatic testing in these patients.

Methods: Retrospective review of children admitted to the PICU and CICU from 2021-2022 supported with ECMO. Patients excluded if weight < 3 kg, ECMO duration < 6 hours. Extracted data included demographics, ECMO cannulation site and duration, conventional coagulation labs, ROTEM results, and complications including bleeding and thrombosis; defined per ELSO Registry definitions. Ordinal logistic regression was performed to assess the value of conventional lab and ROTEM results among patients with no complications, patients with bleeding, patients with thrombosis, and patients with both.

Results: Of the 124 patients enrolled, 41 (33%) had no complications, 18 (14%) had thrombotic complications, 32 (26%) had bleeding, and 33 (26%) had both bleeding and thrombosis. The INTEM clotting time (CT) on day 1 showed a significant difference amongst all groups (p=0.024); the most significant interactions were noted in the patients with both bleeding and thrombotic complications when compared against patients with no complications (p=0.009), compared against patients with thrombosis (p=0.021), compared against patients with bleeding (p=0.024). Similar interactions were also noted in INTEM CT on day 2. EXTEM CT, HEPTEM CT, and FIBTEM MCF did not show significant differences in results amongst the groups. In the conventional laboratory results, there were no significant differences in results noted amongst the groups on any day of testing.

Conclusions: In pediatric patients receiving ECMO, hemostatic monitoring in the first day of therapy may provide information in identifying patients at higher risks for hemostatic complications. Beyond day 1, routine monitoring via viscoelastic hemostatic testing or conventional coagulation testing may not provide additional information in predicting patients at risk for hemostatic complications.