Antithrombin Replacement and Extracorporeal Membrane Oxygenation: The time is ripe for a Simpler Solution

Seelhammer, Troy G.; Hamzah, Mohammed; Wieruszewski, Patrick M.

doi:10.1097/mat.0000000000001704

Cited by 3 publications

(6 citation statements)

References 10 publications

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“…28 Further studies in children are needed to evaluate the potential benefits of AT3 supplementation. 13,16,19 While the clinical benefits of AT3 administration are unclear, the financial costs are evident. 19,20 The average cost of a pediatric ECMO dose of AT3 in the US is estimated at $723.…”

Section: Resultsmentioning

confidence: 99%

“…Some adult studies also suggest that AT3 could reduce inflammation 28 . Further studies in children are needed to evaluate the potential benefits of AT3 supplementation 13,16,19 …”

Section: Discussionmentioning

confidence: 99%

“…While the clinical benefits of AT3 administration are unclear, the financial costs are evident 19,20 . The average cost of a pediatric ECMO dose of AT3 in the US is estimated at $723 20 .…”

Section: Discussionmentioning

confidence: 99%

“…18 While commonly used, the evidence to support exogenous AT3 administration for patients on ECMO is limited. 19,20 Given the limited data concerning the effectiveness of AT3 supplementation for neonatal and pediatric patients on ECMO, we analyzed the Bleeding and Thrombosis during ECMO (BATE) database of 514 patients < 19 years old to determine if AT3 administration improved patient outcomes. We hypothesized that AT3 supplementation would be associated with lower rates of thrombosis and higher rates of bleeding.…”

mentioning

confidence: 99%

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Antithrombin III supplementation during neonatal and pediatric extracorporeal membrane oxygenation

Meshulami,

Green,

Kaushik

2023

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BackgroundBleeding and thrombosis are common extracorporeal membrane oxygenation (ECMO) complications associated with increased mortality. Heparin is the most commonly used ECMO anticoagulant, employed in 94% of cases. Reduced antithrombin III (AT3) levels could decrease heparin effectiveness. Neonates have inherently lower levels of AT3 than adults, and pediatric patients on ECMO can develop AT3 deficiency. One potential approach for patients on ECMO with AT3 deficiency is exogenous AT3 supplementation. However, there is conflicting data concerning the use of AT3 for pediatric and neonatal patients on ECMO.MethodsWe analyzed the Bleeding and Thrombosis during ECMO database of 514 neonatal and pediatric patients on ECMO. We constructed daily regression models to determine the association between AT3 supplementation and rates of bleeding and thrombosis. Given the physiological differences between pediatric patients and neonates, we constructed separate models for each.ResultsAT3 administration was associated with increased rates of daily bleeding among pediatric (adjusted odds ratio [aOR] 1.59, p < 0.01) and neonatal (aOR 1.37, p = 0.04) patients. AT3 supplementation did not reduce the rate of thrombosis for either pediatric or neonatal patients.ConclusionAT3 administration was associated with increased rates of daily bleeding, a hypothesized potential complication of AT3 supplementation. In addition, AT3 supplementation did not result in lower rates of thrombosis. We recommend clinicians utilize caution when considering supplementing patients on ECMO with exogenous AT3.

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Section: Resultsmentioning

confidence: 99%

“…Some adult studies also suggest that AT3 could reduce inflammation 28 . Further studies in children are needed to evaluate the potential benefits of AT3 supplementation 13,16,19 …”

Section: Discussionmentioning

confidence: 99%

“…While the clinical benefits of AT3 administration are unclear, the financial costs are evident 19,20 . The average cost of a pediatric ECMO dose of AT3 in the US is estimated at $723 20 .…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Antithrombin III supplementation during neonatal and pediatric extracorporeal membrane oxygenation

Meshulami,

Green,

Kaushik

2023

Artificial Organs

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“…Considerable controversy remains with regard to optimal anticoagulant intensity, titration strategy (e.g., frequency of laboratory assessment and assay utilized), antithrombin replacement in patients receiving unfractionated heparin [ 65 , 66 ], and the biocompatible surface coating employed advances in durable biocompatible coatings (covalently or ionically bonded heparinoids, phosphorylcholine, poly acrylates) [ 67 ] have facilitated surface coating of most components, including polymethylpentene membrane oxygenators, and allow patients to be maintained on low, or even absent, levels of anticoagulation for prolonged periods with acceptably low rats of complication [ 68 ]. Bleeding complications for ECMO patients are frequent and include cannulation and/or surgical site bleeding, gastrointestinal hemorrhage, cardiac tamponade, pulmonary hemorrhage, and central nervous system bleeds (Table 1 ) [ 56 , 69 ].…”

Section: Cannulation and General Managementmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in Acute Respiratory Failure

et al. 2023

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Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is a form of mechanical life support that provides full respiratory bypass in patients with severe respiratory failure as a bridge to recovery or lung transplantation. The use of ECMO for respiratory failure and capable centers offering ECMO has expanded over the years, increasing its availability. As VV-ECMO provides an artificial mechanism for oxygenation and decarboxylation of native blood, it allows for an environment in which safer mechanical ventilatory care may be provided, allowing for treatment and resolution of underlying respiratory pathologies. Landmark clinical trials have provided a framework for better understanding patient selection criteria, resource utilization, and outcomes associated with ECMO when applied in settings of refractory respiratory failure. Maintaining close vigilance and management of complications during ECMO as well as identifying strategies post-ECMO (e.g., recovery, transplantation, etc.), are critical to successful ECMO support. In this review, we examine considerations for candidate selection for VV-ECMO, review the evidence of utilizing VV-ECMO in respiratory failure, and provide practical considerations for managing respiratory ECMO patients, including complication identification and management, as well as assessing for the ability to separate from ECMO support and the procedures for decannulation.

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