Analysis of Viscoelastic Testing in Pediatric Patients Using the Pediatric Extracorporeal Membrane Oxygenation Outcomes Registry

Abstract

Use of viscoelastic tests (VETs), including thromboelastography (TEG) and rotational thromboelastometry (ROTEM), is increasing in the management of anticoagulation in extracorporeal membrane oxygenation (ECMO) patients. A retrospective review of data on 265 pediatric (<20 years old) ECMO patients who underwent VET and were submitted to the Pediatric ECMO Outcomes Registry (PEDECOR) was conducted to describe common coagulopathies in patients who underwent VET; associations between the VET parameters and traditional tests of coagulation; and comparisons in blood product usage in patients who underwent VET with those who did not. We calculated patient-level summary statistics and assessed differences between the groups using χ 2 tests (categorical variables) and Kruskal-Wallis and Wilcoxon rank-sum tests (continuous variables). Viscoelastic test was utilized in 77% of patients in the analysis. Platelet dysfunction was the most common abnormality identified by TEG (30.8%) and ROTEM (9.7%). Bleeding patients who had VET performed received more cryoprecipitate transfusions than those who did not have VET (VET median = 9.7 ml/kg; interquartile range (IQR) = 4.3-22.0 ml/kg vs. no VET median = 5.1 ml/kg; IQR = 0-10.4 ml/kg; p = 0.0013). Given the growing use of VET in pediatric ECMO patients, further studies evaluating VET in managing complications as well as aiding in titration of anticoagulation therapy are needed.

Extracorporeal Membrane Oxygenation Outcomes in Children With Preexisting Neurologic Disorders or Neurofunctional Disability*

“…We conducted a retrospective observational cohort study using multicenter Pediatric ECMO Outcomes Registry (PEDECOR) data from October 2011 to June 2019. PEDECOR was built using a secure web-based data platform housed at the Baylor College of Medicine Dan L. Duncan Institute for Clinical and Translational Research (16, 17). The registry includes all patients who undergo ECMO at each participating center and collects data including demographics, preadmission diagnoses, pre-ECMO course, ECMO mode and course characteristics, laboratory results and medications, and transfusions administered during the ECMO course, as well as post-ECMO disposition.…”

Thromboelastography in the Perioperative Period: A Literature Review

“…Few studies investigated the role of TEG among pediatric patients undergoing general surgical procedures and they found that applying TEG or ROTEM in pediatric patients increased coagulopathy risk and blood products use [ 188 ] while in neonates, TEG parameters predicted sepsis early [ 189 ]. Also, TEG-guided transfusion decreased blood products use compared to clinician-guided transfusion while in mortality and morbidity risks, no differences were detected [ 190 ].…”

Viscoelastic Testing in Pediatric Mechanical Circulatory Support

“…Figures 3, 4 describe the clinical features and TEG R /ROTEM R parameters that have been associated with increased bleeding and thrombotic complications. In a recent report using data from 265 children in the Pediatric ECMO Outcomes Registry (PEDECOR) VET was utilized in ¾ of centers contributing data, although bleeding and thrombotic complications were not different between centers utilizing VET compared to centers that did not (60). We review these pediatric studies below and in Table 3.…”

“…Alexander et al found a weak correlation of the TEG R heparinase variables and the aPTT/ACT, but a stronger correlation between the TEG R MA and platelet count (62). In the PEDECOR study, VET identified platelet dysfunction most commonly and bleeding patients who had VET performed received more cryoprecipitate transfusions than those who did not have VET (60). A chart review of children <18 years on ECMO looked at severe platelet dysfunction (<50% aggregation on TEG R PM) and bleeding.…”