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

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 infusion improves anticoagulation in congenital diaphragmatic hernia patients on extracorporeal membrane oxygenation

Perfusion ◽

10.1177/02676591211063805 ◽

2021 ◽

pp. 026765912110638

Author(s):

Tanya Perry ◽

Brandon Henry ◽

David S Cooper ◽

Sundeep G Keswani ◽

Kimberly S Burton ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Congenital Diaphragmatic Hernia ◽

Continuous Infusion ◽

Diaphragmatic Hernia ◽

Antithrombin Iii ◽

Factor Xa ◽

Heparin Infusion ◽

Membrane Oxygenation ◽

At Iii ◽

Life Threatening

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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Cisatracurium Continuous Infusion versus No Neuromuscular Blockade for Acute Respiratory Distress Syndrome on Veno‐venous Extracorporeal Membrane Oxygenation

The Journal of Clinical Pharmacology ◽

10.1002/jcph.1933 ◽

2021 ◽

Author(s):

Christian Kressin ◽

Melissa Thompson Bastin ◽

Ayesha Ather ◽

Anil Gopinath ◽

Habib Srour ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Continuous Infusion ◽

Neuromuscular Blockade ◽

Distress Syndrome ◽

Membrane Oxygenation

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Inter-Hospital Transport of Neonatal Patients on Extracorporeal Membrane Oxygenation: Mobile-ECMO

PEDIATRICS ◽

10.1542/peds.95.4.562 ◽

1995 ◽

Vol 95 (4) ◽

pp. 562-566

Author(s):

Mark J. Heulitt ◽

Bonnie J. Taylor ◽

Sherry C. Faulkner ◽

Lorrie L. Baker ◽

Carl W. Chipman ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Case Series ◽

High Frequency Ventilation ◽

Medical Patients ◽

Retrospective Case ◽

Membrane Oxygenation ◽

Limited Series ◽

Frequency Ventilation ◽

Hospital Transport

Objective. To describe the equipment, personnel requirements, training, management techniques, and logistic problems encountered in the design and implementation of a mobile extracorporeal membrane oxygenation (ECMO) program. Design. This is a report of a technique for the transport of patients on ECMO and a description of our retrospective case series. Settings. The study was conducted at a regional referral children's hospital and ECMO unit. Patients. Thirteen neonatal medical patients with acute respiratory failure were transported with mobile-ECMO. Results. Over a 24-month period, we transported 13 neonatal patients with mobile-ECMO. The reason for transport with mobile-ECMO was inability to convert from high-frequency ventilation (4 of 13), patient already on ECMO (1 of 13), and patient deemed too unstable for conventional transport (8 of 13). Eleven of the 13 patients were transported from other ECMO centers. Of the 13, 9 survived. No major complications during transport were reported for any of the patients. Follow-up data were available on all nine survivors of neonatal mobile- ECMO. Eight of these had normal magnetic resonance imaging scans of the brain; the ninth had a small hemorrhage in the left cerebellum. Conclusion. Our limited series shows that patients can be safely transported with mobile-ECMO. This program does not replace the early appropriate transfer for ECMO-eligible patients to an ECMO center.

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Opioid withdrawal in neonates after continuous infusions of morphine or fentanyl during extracorporeal membrane oxygenation

American Journal of Critical Care ◽

10.4037/ajcc1998.7.5.364 ◽

1998 ◽

Vol 7 (5) ◽

pp. 364-369 ◽

Cited By ~ 97

Author(s):

LS Franck ◽

J Vilardi ◽

D Durand ◽

R Powers

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Continuous Infusion ◽

Opioid Withdrawal ◽

Opioid Analgesia ◽

Lower Prevalence ◽

Membrane Oxygenation ◽

Prospective Group

BACKGROUND: Complications of opioid analgesia include tolerance and withdrawal. OBJECTIVES: To determine the effects of morphine and fentanyl on the prevalence of withdrawal after extracorporeal membrane oxygenation. METHODS: Two groups of neonates were compared during and after extracorporeal membrane oxygenation: a prospective group receiving a continuous infusion of morphine for analgesia and sedation and a retrospective group who had received a continuous infusion of fentanyl. RESULTS: Neonates receiving morphine required significantly less supplemental analgesia (P < .001) than did neonates who had received fentanyl and had a significantly lower prevalence of withdrawal after the therapy (P = .01). Neonates receiving morphine were discharged from the hospital a mean of 9.6 days sooner (P = .01) than neonates who had received fentanyl. CONCLUSIONS: Morphine may offer marked advantages over fentanyl for providing continuous analgesia and sedation in neonates.

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Outcomes of pediatric oncology and hematopoietic cell transplant patients receiving extracorporeal membrane oxygenation

Perfusion ◽

10.1177/0267659119842471 ◽

2019 ◽

Vol 34 (7) ◽

pp. 598-604

Author(s):

Danielle K Maue ◽

Michael J Hobson ◽

Matthew L Friedman ◽

Elizabeth AS Moser ◽

Courtney M Rowan

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Extracorporeal Membrane Oxygenation ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Hematopoietic Cell ◽

Cell Transplant ◽

Hematopoietic Cell Transplant ◽

Membrane Oxygenation ◽

Transplant Patients

Background/objectives: There is controversy regarding the utilization of extracorporeal membrane oxygenation in pediatric patients with an underlying oncologic diagnosis or who have undergone hematopoietic cell transplant. We hypothesized that these patients have higher mortality, more bleeding complications, more blood product utilization, and a higher rate of new infections than the general pediatric intensive care unit population supported with extracorporeal membrane oxygenation. Design/methods: This is a retrospective chart review at a single center quaternary care pediatric hospital including all pediatric intensive care unit extracorporeal membrane oxygenation patients from 2011 to 2016. Patients were categorized as either oncology/hematopoietic cell transplant or general pediatric intensive care unit. Patients from the cardiovascular intensive care unit or the neonatal intensive care unit were excluded. Results: A total of 38 patients met inclusion criteria of which 7 were oncology/hematopoietic cell transplant patients. The oncology/hematopoietic cell transplant group had lower platelets at the start of extracorporeal membrane oxygenation (p = 0.02) but other pre-extracorporeal membrane oxygenation characteristics were similar. Extracorporeal membrane oxygenation survival was lower in the oncology/hematopoietic cell transplant group (29% vs 77%, p = 0.02). The incidence of bleeding complications and new infections did not differ. The oncology/hematopoietic cell transplant group received more platelets (median of 15.9 mL/kg/day (interquartile range 8.4, 36.6) vs 7.9 mL/kg/day (3.3, 21.9), p = 0.04) and fresh frozen plasma (14.0 mL/kg/day (3, 15.7) vs 1.8 mL/kg/day (0.5, 5.9), p = 0.04). Conclusion: Oncology and hematopoietic cell transplant patients had a higher mortality and received more blood products while on extracorporeal membrane oxygenation than the general pediatric intensive care unit patients despite similar pre-extracorporeal membrane oxygenation characteristics. Physicians should use caution when deciding whether or not to utilize extracorporeal membrane oxygenation in this population.

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Correlation Among Antifactor Xa, Activated Partial Thromboplastin Time, and Heparin Dose and Association with Pediatric Extracorporeal Membrane Oxygenation Complications

ASAIO Journal ◽

10.1097/mat.0000000000000986 ◽

2020 ◽

Vol 66 (3) ◽

pp. 307-313 ◽

Cited By ~ 2

Author(s):

Ali B. V. McMichael ◽

Christoph P. Hornik ◽

Susan R. Hupp ◽

Sharon E. Gordon ◽

Caroline P. Ozment

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Partial Thromboplastin Time ◽

Activated Partial Thromboplastin Time ◽

Heparin Dose ◽

Membrane Oxygenation ◽

Antifactor Xa

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Population Pharmacokinetics of Meropenem in Plasma and Subcutis from Patients on Extracorporeal Membrane Oxygenation Treatment

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02390-17 ◽

2018 ◽

Vol 62 (5) ◽

Cited By ~ 9

Author(s):

Pelle Hanberg ◽

Kristina Öbrink-Hansen ◽

Anders Thorsted ◽

Mats Bue ◽

Mikkel Tøttrup ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Continuous Infusion ◽

Prospective Observational Study ◽

Plasma Concentrations ◽

Content Type ◽

Membrane Oxygenation ◽

Population Pk ◽

Dosing Regimens ◽

Subcutaneous Adipose ◽

Ecmo Treatment

ABSTRACTThe objectives of this study were to describe meropenem pharmacokinetics (PK) in plasma and/or subcutaneous adipose tissue (SCT) in critically ill patients receiving extracorporeal membrane oxygenation (ECMO) treatment and to develop a population PK model to simulate alternative dosing regimens and modes of administration. We conducted a prospective observational study. Ten patients on ECMO treatment received meropenem (1 or 2 g) intravenously over 5 min every 8 h. Serial SCT concentrations were determined using microdialysis and compared with plasma concentrations. A population PK model of SCT and plasma data was developed using NONMEM. Time above clinical breakpoint MIC forPseudomonas aeruginosa(8 mg/liter) was predicted for each patient. The following targets were evaluated: time for which the free (unbound) concentration is maintained above the MIC of at least 40% (40%fT>MIC), 100%fT>MIC, and 100%fT>4×MIC. For all dosing regimens simulated in both plasma and SCT, 40%fT>MIC was attained. However, prolonged meropenem infusion would be needed for 100%fT>MIC and 100%fT>4×MIC to be obtained. Meropenem plasma and SCT concentrations were associated with estimated creatinine clearance (eCLCr). Simulations showed that in patients with increased eCLCr, dose increment or continuous infusion may be needed to obtain therapeutic meropenem concentrations. In conclusion, our results show that using traditional targets of 40%fT>MIC for standard meropenem dosing of 1 g intravenously every 8 h is likely to provide sufficient meropenem concentration to treat the problematic pathogenP. aeruginosafor patients receiving ECMO treatment. However, for patients with an increased eCLCr, or if more aggressive targets, like 100%fT>MIC or 100%fT>4×MIC, are adopted, incremental dosing or continuous infusion may be needed.

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Comparison of atrio-femoral and femoro-atrial venovenous extracorporeal membrane oxygenation in adult

Perfusion ◽

10.1177/0267659120969020 ◽

2020 ◽

pp. 026765912096902

Author(s):

Steven Kin-ho Ling

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Case Control Study ◽

Case Control ◽

Single Centre ◽

Retrospective Case ◽

Membrane Oxygenation ◽

Venovenous Extracorporeal Membrane Oxygenation ◽

Control Study ◽

Ecmo Flow ◽

Vv Ecmo

Introduction: Different cannulation approaches existed for veno-venous extracorporeal membrane oxygenation (VV ECMO). We aimed to compare the atrio-femoral (AF) and femoro-atrial (FA) configuration in terms of their flow efficiency and influence on patient outcome. Method: This was a single-centre, retrospective case control study. Adult patients admitted to the Intensive Care Unit and required VV ECMO service at Tuen Mun Hospital, Hong Kong, from June 2015 to January 2020 were included. Data were collected from our ECMO database for comparison. Results: Between June 2015 and January 2020, eight patients received AF configuration and 19 patients received FA configuration. The maximum achieved flow in the AF group was significantly higher than that in the FA group (4.08 ± 0.57 L/min vs. 3.52 ± 0.58 L/min, p = 0.03). The fluid balance in first 3 days of ECMO was significantly lower in the AF group compared to that in the FA group (1.16 ± 2.71 L vs. 3.46 ± 1.97 L, p = 0.02). As well, the chance for successful awake ECMO was statistically higher in the AF group (p = 0.048). Conclusion: Atrio-femoral configuration in VV ECMO was associated with a higher maximum achieved ECMO flow, less fluid gain in first 3 days of ECMO and more successful awake ECMO.

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