Activation of the clotting system during extracorporeal membrane oxygenation in term newborn infants

• Published in: The Journal of pediatrics Vol. 129; no. 2; pp. 264 - 268
• Main Authors: Urlesberger, Berndt, Zobel, G., Zenz, W., Kuttnig-Haim, Michaela, Maurer, Ute, Reiterer, F., Riccabona, M., Dacar, D., Gallistl, S., Leschnik, Bettina, Muntean, W.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.08.1996; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anticoagulants - administration & dosage; Anticoagulants - therapeutic use; Antithrombin III - analysis; Batroxobin - blood; Biological and medical sciences; Blood Coagulation; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Equipment Design; Extracorporeal Membrane Oxygenation - instrumentation; Fibrin Fibrinogen Degradation Products - analysis; Fibrinogen - analysis; Follow-Up Studies; Heparin - administration & dosage; Heparin - therapeutic use; Humans; Infant, Newborn - blood; Intensive care medicine; Intubation - instrumentation; Medical sciences; Membranes, Artificial; Peptide Fragments - analysis; Peptide Hydrolases - analysis; Platelet Count; Prothrombin - analysis; Prothrombin Time; Silicone Elastomers; Silicones; Whole Blood Coagulation Time; ECMO; ACT; AT III; TAT; Human; Cardiopulmonary bypass; Membrane oxygenator; Newborn; Activation; Anticoagulant; Coagulation factor; Quantitative analysis
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(96)70252-4

OBJECTIVE: To determine the degree of clotting activation that occurs with the usual anticoagulation regimen with systemic heparinization. METHODS: To allow a standardized comparison of the patients, this study focused on the first 48 hours of extracorporeal membrane oxygenation (ECMO) in term newborn infants. The ECMO perfusion circuit consisted of a roller pump, silicone membrane lungs, and silicone rubber tubing. Coagulation was controlled routinely by measuring prothrombin time, fibrinogen, antithrombin III, and reptilase time. Platelet counts, activated clotting time, and heparin concentration were controlled regularly. The following specific activation markers of the clotting system were measured: prothrombin activation fragment 1 + 2 (F 1 + 2), thrombin-antithrombin III complexes, and D-dimer. Measurements were done before the start of ECMO, after 5 minutes, and at hours 1, 2, 3, 4, 6, 12, 24 and 48. RESULTS: All seven term infants had excessively high levels of clotting activation markers within the first 2 hours of ECMO: F l + 2, 11.6 (±0.9) nmol/L (mean ± SEM); thrombin-antithrombin, 920 (±2.2) μg/L; D-dimer, 15.522 (±3.689) ng/L. During the next 46 hours of ECMO, F l + 2 and thrombin-antithrombin III complexes decreased from those high values, whereas D-dimer did not. The increase of activation markers was accompanied by low fibrinogen, low platelet counts. and prolongation of reptilase time. CONCLUSIONS: These findings fit the pattern of consumptive coagulopathy during neonatal ECMO, especially in the first 24 hours. (J P EDIATR 1996;129:264-8)