Continuous antithrombin III administration in pediatric veno-arterial extracorporeal membrane oxygenation

Kristina M. Nelson, Lizbeth A. Hansen, Marie E Steiner, Gwenyth Fischer, John Dehnel, Sameer Gupta

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

The purpose of this retrospective case-control study is to determine the effect of continuous antithrombin III (ATIII) infusion on extracorporeal membrane oxygenation (ECMO) coagulation. All ECMO patients within the pediatric intensive care unit from January 2012 to July 2014 were included. Comparison was made between those who received continuous infusion ATIII through a standardized replacement protocol with historic controls receiving intermittent ATIII doses. Patients receiving the continuous infusion ATIII protocol spent more time in goal ACT range (71.9% vs 52.2%, p < 0.0001). Mean daily ATIII activity was also increased in study group (77.3% versus 68.6%, p = 0.04). No statistical differences in number of heparin dose changes per day (3 versus 3.22, p = 0.90) were present between the 2 groups. Only 28% of the historic controls receiving intermittent ATIII doses achieved normal ATIII activity as compared with 80% of study patients (p = 0.24). Maximum heparin dose was also lower in continuous infusion protocol group (p < 0.01). Compared with nonprotocolized intermittent dosing, the use of a continuous infusion ATIII protocol demonstrated increased time within goal ACT range at a lower heparin dose, no increase in hemostatic complications, and trends toward fewer heparin changes and lower blood product usage.

Original languageEnglish (US)
Pages (from-to)266-271
Number of pages6
JournalJournal of Pediatric Pharmacology and Therapeutics
Volume22
Issue number4
DOIs
StatePublished - Jul 1 2017

Bibliographical note

Publisher Copyright:
© Pediatric Pharmacy Advocacy Group. All rights reserved.

Keywords

  • Anticoagulation
  • Antithrombin
  • Critical care
  • ECMO
  • Pediatrics

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