(517) Blood Product Utilization After Invasive Procedures in Pediatric ECMO

Monday, February 24, 2025

2:30pm – 3:30pm Eastern Time

Location: Connections Central - RST 09

First Author(s)

Rachel A. Slate, MD (she/her/hers)

Pediatric Critical Care Fellow
University of Arkansas for Medical Sciences
Little Rock, Arkansas, United States

Co-Author(s)

OI

Olivia Irby, MD

Associate Professor of Pediatrics, PCCM Fellowship Program Director
University of Arkansas for Medical Sciences, United States
Matthew P. Malone, MD

Associate Professor of Pediatrics, ECMO Medical Director, PCCM Fellowship Associate Program Director
University of Arkansas for Medical Sciences
Little Rock, United States
BF

Blake Frazier, RN

ECMO Program Manager, ECMO Coordinator/Specialist
Arkansas Childrens Hospital, United States
AM

Amber Miller, RN

ECMO Coordinator/Specialist
Arkansas Childrens Hospital, United States
PP

Parthak Prodhan, MD, MBA

Medical Director CVICU, Professor of Pediatrics
University of Arkansas for Medical Sciences, United States
FM

Franscesca Miquel-Verges, MD

Professor of Pediatrics, Division of Neonatology
University of Arkansas for Medical Sciences, United States
EB

Erin Bennett, MD

Associate Professor of Pediatrics, Medical Director Pediatric Intensive Care Unit
University of Arkansas for Medical Sciences, United States

Introduction: Extracorporeal membrane oxygenation (ECMO) is a life-sustaining support modality for critically ill pediatric patients with cardiorespiratory failure. Bleeding and thrombosis are significant complications contributing to morbidity and mortality while on ECMO, and the bleeding risk often precludes invasive procedures from occurring. Traditionally, unfractionated heparin (UFH) has been used for systemic anticoagulation. However, bivalirudin, a direct-thrombin inhibitor, has been shown to be safe and efficacious, although there is a paucity of literature evaluating its use during invasive procedures in pediatric patients. We hypothesize that anticoagulation with bivalirudin in pediatric patients is not associated with increased major bleeding complications as compared to anticoagulation with heparin, when adjusting for other risk factors.

Methods: Retrospective chart review was performed for all patients less than 18 years of age on ECMO between 2018-2023 at Arkansas Children's Hospital. Patients were excluded if over the age of 18 years, on subsequent ECMO runs, died within 24 hours of ECMO cannulation, and/or had a known pre-existing coagulopathy. Data was obtained from the electronic medical record (EMR) as well as the Extracorporeal Life Support Organization (ELSO) registry, which included demographics, ECMO details, invasive procedures, bleeding and thrombotic complications. Major bleeding is defined using the Bleeding Assessment Scale in critically Ill Children (BASIC).

Results: 215 patients required ECMO support between 2018-2023. 184 patients met inclusion criteria. Most patients (73%) had at least one invasive procedure performed on ECMO with a total of 402 invasive procedures performed during this time frame. 56% were anticoagulated with UFH at the time of procedure compared to 40% with bivalirudin. Patients anticoagulated with UFH tended to require more blood products than patients anticoagulated with bivalirudin.

Conclusions: Our goal is to support providers’ decisions about safety and efficacy of anticoagulation use while on ECMO. Increased blood product utilization after invasive procedures when anticoagulated with UFH as compared to bivalirudin suggests there may be an increased incidence of bleeding complications, for which additional data collection and analysis is ongoing.