Background: Bleeding and thromboembolism continue to be the greatest cause of morbidity and mortality during extracorporeal membrane oxygenation (ECMO). The activated clotting time (ACT) remains a standard for heparin management in both ECMO and cardiopulmonary bypass (CPB), despite its weak correlation to the lower plasma heparin levels of ECMO. Furthermore, little is known about the hemostatic alterations related to ECMO versus CPB in children. We hypothesize that the hemostatic profile of ECMO patients differs significantly from those undergoing CPB, and furthermore that age-specific differences exist between neonatal and pediatric ECMO patients.
Methods: A prospective observational study evaluating antithrombin III (ATIII), fibrinolysis, thrombin generation, platelet activation and platelet response to agonist during CPB and ECMO at baseline, 4 and 24 hrs. Differences between age groups (neonatal vs. pediatric) in the ECMO group were also compared at baseline, 4, 12, 24, 72, and 144 hrs respectively.
Results: The ECMO group was younger, weighed less, and had a lower body surface index than the CPB group. There were significant differences in baseline ATIII levels, platelet functionality, D-Dimer, and F1+2 concentrations between groups. Dichotomization of the ECMO group revealed that D-Dimer and F1+2 generation increased with time in neonatal patients.
Conclusions: ECMO generally had greater impact on the hemostatic system than CPB. Circulating platelets were less responsive and markers of fibrinolytic and coagulation activation were greater in the ECMO group at all 3 time points compared between the two therapies. Fibrinolytic and coagulation activation increased with time significantly in the neonatal ECMO population.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-07152011-173425 |
| Date | 19 September 2011 |
| Creators | Wolff, Erin Lynn |
| Contributors | Peter Wearden, MD, PhD, Harvey Borovetz, William Wagner, PhD |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-07152011-173425/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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