978: CLINICAL EFFECTS OF ANTITHROMBIN III LEVEL ON ANTICOAGULATION IN EXTRACORPOREAL MEMBRANE OXYGENATION

Purpose Achieving effective anticoagulation during neonatal extracorporeal membrane oxygenation (ECMO) without increasing the risk of hemorrhage remains challenging. The use of antithrombin III (AT-III) for this purpose has been examined, but studies have been limited to intermittent bolus dosing. We aimed to evaluate the efficacy and safety of an institutionally developed AT-III continuous infusion protocol in neonates receiving ECMO for the treatment of congenital diaphragmatic hernia (CDH). Methods In this single center, retrospective study, all neonates with a CDH who received ECMO support during the study period were included. Data on anticoagulation labs and therapy, life-threatening bleeding, and circuit changes were analyzed. Results Eleven patients were divided into two groups: patients with AT-III continuous infusion ( n = 5) and without ( n = 6). There were no differences in the gestational age ( p = 0.29), sex ( p = 1.00), ECMO duration ( p = 0.59), or initial AT-III levels ( p = 0.76) between groups. Patients in the AT-III infusion group had on average 18.5% higher AT-III levels ( p < 0.0001). Patients receiving continuous AT-III infusions spent a significantly higher percentage of ECMO time within the therapeutic range, measured using anti-Factor Xa levels (64.9±4.2% vs. 29.1±8.57%, p = 0.008), and required fewer changes to the heparin infusion rate (6.48±0.88 vs 2.38±0.36 changes/day changes/day, p = 0.005). Multivariate analysis revealed continuous infusion of AT-III did not increase the rate of intracranial or surgical bleeding ( p = 0.27). Conclusion AT-III as a continuous infusion in CDH neonates on ECMO provides a decreased need to modify heparin infusion and more consistent therapeutic anticoagulation without increasing the risk of life-threatening bleeding.

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Antithrombin III Deficiency in Patients Requiring Extracorporeal Membrane Oxygenation (ECMO) Support

CHEST Journal ◽

10.1378/chest.1703464 ◽

2013 ◽

Vol 144 (4) ◽

pp. 319A

Author(s):

Jonathan Sarik ◽

Shinya Unai ◽

Harrison Pitcher ◽

Qiong Yang ◽

Hitoshi Hirose ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Antithrombin Iii ◽

Ecmo Support ◽

Membrane Oxygenation ◽

Antithrombin Iii Deficiency

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Continuous Antithrombin III Administration in Pediatric Veno-Arterial Extracorporeal Membrane Oxygenation

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-22.4.266 ◽

2017 ◽

Vol 22 (4) ◽

pp. 266-271 ◽

Cited By ~ 1

Author(s):

Kristina M. Nelson ◽

Lizbeth A. Hansen ◽

Marie E. Steiner ◽

Gwenyth A. Fischer ◽

John Dehnel ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Continuous Infusion ◽

Antithrombin Iii ◽

Pediatric Intensive Care ◽

Heparin Dose ◽

Retrospective Case ◽

Product Usage ◽

Membrane Oxygenation ◽

Lower Blood ◽

Infusion Protocol

The purpose of this retrospective case-control study is to determine the effect of continuous antithrombin III (ATIII) infusion on extracorporeal membrane oxygenation (ECMO) coagulation. All ECMO patients within the pediatric intensive care unit from January 2012 to July 2014 were included. Comparison was made between those who received continuous infusion ATIII through a standardized replacement protocol with historic controls receiving intermittent ATIII doses. Patients receiving the continuous infusion ATIII protocol spent more time in goal ACT range (71.9% vs 52.2%, p < 0.0001). Mean daily ATIII activity was also increased in study group (77.3% versus 68.6%, p = 0.04). No statistical differences in number of heparin dose changes per day (3 versus 3.22, p = 0.90) were present between the 2 groups. Only 28% of the historic controls receiving intermittent ATIII doses achieved normal ATIII activity as compared with 80% of study patients (p = 0.24). Maximum heparin dose was also lower in continuous infusion protocol group (p < 0.01). Compared with nonprotocolized intermittent dosing, the use of a continuous infusion ATIII protocol demonstrated increased time within goal ACT range at a lower heparin dose, no increase in hemostatic complications, and trends toward fewer heparin changes and lower blood product usage.

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Antithrombin III Supplementation on Extracorporeal Membrane Oxygenation

ASAIO Journal ◽

10.1097/mat.0000000000000010 ◽

2014 ◽

Vol 60 (1) ◽

pp. 57-62 ◽

Cited By ~ 36

Author(s):

Jonathan W. Byrnes ◽

Christopher J. Swearingen ◽

Parthak Prodhan ◽

Richard Fiser ◽

Umesh Dyamenahalli

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Antithrombin Iii ◽

Membrane Oxygenation

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Exogenous supplementation of antithrombin III in adult and pediatric patients receiving extracorporeal membrane oxygenation

The International Journal of Artificial Organs ◽

10.1177/0391398819888932 ◽

2019 ◽

Vol 43 (5) ◽

pp. 315-322 ◽

Cited By ~ 1

Author(s):

Mark N Sorial ◽

Rebecca A Greene ◽

Andrew R Zullo ◽

Christine Berard-Collins ◽

Steve Willis

Keyword(s):

Standard Deviation ◽

Extracorporeal Membrane Oxygenation ◽

Antithrombin Iii ◽

P Value ◽

Heparin Infusion ◽

Membrane Oxygenation ◽

Heparin Resistance ◽

Heparin Anticoagulation ◽

Antithrombin Iii Deficiency ◽

Antithrombin Iii Activity

Background: Antithrombin III deficiency can occur with heparin anticoagulation during extracorporeal membrane oxygenation leading to heparin resistance. Antithrombin III supplementation has been shown to improve anticoagulation; however, there is no consensus on appropriate administration. We described the effect of antithrombin III supplementation on coagulation parameters in adult and pediatric extracorporeal membrane oxygenation patients. Methods: We conducted a retrospective cohort study using electronic medical records of patients who received ⩾1 dose of antithrombin III during extracorporeal membrane oxygenation while on continuous heparin. Endpoints included the change in anti-Xa levels and antithrombin III activity at −6 versus 6 h relative to antithrombin III supplementation, and heparin infusion rates at 6 versus 12 h after antithrombin III supplementation. Results: Eighteen patients receiving 36 antithrombin III administrations were analyzed. Mean (standard deviation) anti-Xa values at −6 versus 6 h were 0.15 (0.07) versus 0.24 (0.15) IU/mL ( p-value: 0.250) for pediatrics and 0.19 (0.22) versus 0.31 (0.27) IU/mL ( p-value: 0.052) for adults. Mean (standard deviation) plasma antithrombin III activity at the same intervals were 32% (14.2%) versus 66.8% (25.1%; p-value: 0.062) for pediatrics and 30.3% (14%) versus 52.8% (8.1%; p-value: 0.094) for adults. Mean (standard deviation) heparin rates at 6 versus 12 h after antithrombin III for pediatrics were 23.6 (6) versus 23.5 (6.5) units/kg/h ( p-value: 0.728), and 15.3 (6.6) versus 13.5 (8) units/kg/h ( p-value: 0.188) for adults. Conclusion: Administration of antithrombin III improved anti-Xa levels in both populations, however, did not significantly reduce heparin rates. Our findings suggest that the use of antithrombin III restores heparin responsiveness in patients with low antithrombin III activity and low anti-Xa activity.

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CASE STUDY: Cinnamon Aspiration in a Toddler Causing Severe ARDS Requiring Surfactant and Extracorporeal Membrane Oxygenation

10.22541/au.162688099.98087821/v1 ◽

2021 ◽

Author(s):

Gene Peir ◽

Kaitlyn Boggs ◽

Pela Soto ◽

Matthew Sharron ◽

Iman Sami ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Pulmonary Toxicity ◽

Distress Syndrome ◽

Clinical Effects ◽

Hypoxemic Respiratory Failure ◽

Early Presentation ◽

Membrane Oxygenation ◽

Lower Airways

As many as 6% of reported cinnamon poisonings cause significant clinical effects, however descriptions of pulmonary toxicity have not yet been reported. Here, we present a pediatric patient’s hospital course following powdered cinnamon aspiration. The early presentation with hypercapnia and lower airways obstructions evolved to hypoxemic respiratory failure and severe pediatric acute respiratory distress syndrome requiring a 7-day course of veno-venous extracorporeal membrane oxygenation, 16 ventilator-days, and 3 diagnostic and therapeutic bronchoscopies with 2 applications of surfactant therapy. The sum of these modalities contributed to this patient’s survival and subsequent return to respiratory baseline 6 months post-hospitalization.

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