Abstract
The use of extracorporeal membrane oxygenation (ECMO) in the treatment of cardiac complications is growing. Anticoagulation control in pediatrics is one of the most complicated aspects in post-cardiac surgery patients.
This research aimed to determine whether an anticoagulation monitoring protocol in pediatric post-cardiac surgery patients treated with venoarterial (VA) ECMO results in fewer bleeding complications and prolongs survival. This was a retrospective, observational, descriptive, single-arm, study conducted at the Christus Muguerza Hospital in Monterrey, Mexico. The variables were activated clotting time (ACT), activated partial thromboplastin time (aPTT), anti-Factor Xa (anti-Xa) activity, and antithrombin III (AT) parameters. Test results were correlated with the unfractionated Heparin (UFH) infusion rate (IU/kg/h) at the sampling time.
The mean heparin dose was 21.09 IU/kg/hr. ACT got 188.6 seconds, and ACT-based therapeutic anticoagulation got in 180–220 seconds. The aPTT got in this study was 62.15 seconds. The anti-Xa level was 0.27 UL/mL, and the AT level was 47.52 IU. We got a survival rate of 60%. The main hemorrhagic complications were severe bleeding at 10% and systemic thrombosis at 10%. The major complications were sepsis, renal failure, and severe bleeding.
More prospective trials are required to delineate the dose change with UFH and prevent adverse clinical outcomes in different pediatric cardiac surgery conditions.
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