Thromboelastography-guided management of coagulopathy in neonates with congenital diaphragmatic hernia supported by extracorporeal membrane oxygenation

Phillips, Ryan; Shahi, Niti; Leopold, David; Levek, Claire; Shirek, Gabrielle; Hilton, Sarah A.; Hyslop, Rob; Gien, Jason; Kinsella, John P.; Buckvold, Shannon; Liechty, Kenneth W.; Kim, John S.; Marwan, Ahmed I.

doi:10.1007/s00383-020-04694-0

Cited by 26 publications

(17 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Other populations of potential interest include liver transplantation, sepsis, obstetric hemorrhage, perioperative thromboembolism, and management of anticoagulation on mechanical circulator support, though evidence from large trials required to formulate consensus recommendations in these areas is lacking (89). This work is even more limited in pediatric specific populations, though studies have suggested a benefit in similar disease populations as to adults (102,108). That said, viscoelastic testing may be particularly advantageous in pediatric populations since only a small volume of blood is required for sample analysis.…”

Section: Global Measures Of Hemostasismentioning

confidence: 99%

Hemostatic Testing in Critically Ill Infants and Children

Nair

Parker

2021

Front. Pediatr.

View full text Add to dashboard Cite

Children with critical illness frequently manifest imbalances in hemostasis with risk of consequent bleeding or pathologic thrombosis. Traditionally, plasma-based tests measuring clot formation by time to fibrin clot generation have been the “gold standard” in hemostasis testing. However, these tests are not sensitive to abnormalities in fibrinolysis or in conditions of enhanced clot formation that may lead to thrombosis. Additionally, they do not measure the critical roles played by platelets and endothelial cells. An added factor in the evaluation of these plasma-based tests is that in infants and young children plasma levels of many procoagulant and anticoagulant proteins are lower than in older children and adults resulting in prolonged clot generation times in spite of maintaining a normal hemostatic “balance.” Consequently, newer assays directly measuring thrombin generation in plasma and others assessing the stages hemostasis including clot initiation, propagation, and fibrinolysis in whole blood by viscoelastic methods are now available and may allow for a global measurement of the hemostatic system. In this manuscript, we will review the processes by which clots are formed and by which hemostasis is regulated, and the rationale and limitations for the more commonly utilized tests. We will also discuss selected newer tests available for the assessment of hemostasis, their “pros” and “cons,” and how they compare to the traditional tests of coagulation in the assessment and management of critically ill children.

show abstract

Section: Global Measures Of Hemostasismentioning

confidence: 99%

Hemostatic Testing in Critically Ill Infants and Children

Nair

Parker

2021

Front. Pediatr.

View full text Add to dashboard Cite

show abstract

“…13 Viscoelastic testing, which is a global measure of whole blood coagulation, may provide a more physiologic assessment of bleeding risk; however, the evidence supporting this is unclear. 14,15 From the survey referenced, the hemostatic tests used in transfusion protocols varied considerably. 12 Plasma transfusions were guided by INR in 67% of the centers (14/21), fibrinogen in 57% (12/21), prothrombin time in 48% (10/21), activated partial thromboplastin time (aPTT) in 33% (7/21), activated clotting time (ACT) in 29% (6/21), antithrombin level in 29% (6/21), thromboelastography R-time in 19% (4/21), and rotational thromboelastometry A10 and maximum clot firmness in 5% (1/21).The median INR threshold for bleeding patients was 1.5 (IQR, 1.3-1.65) vs 2.0 (IQR, 1.8-2.5) for nonbleeding patients (P = .004).…”

Section: Plasma Transfusionsmentioning

confidence: 99%

“…For example, the international normalized ratio (INR) was developed to monitor warfarin therapy and has inherit weaknesses in the assessment of coagulation factor levels 13 . Viscoelastic testing, which is a global measure of whole blood coagulation, may provide a more physiologic assessment of bleeding risk; however, the evidence supporting this is unclear 14,15 . From the survey referenced, the hemostatic tests used in transfusion protocols varied considerably 12 .…”

Section: Plasma Transfusionsmentioning

confidence: 99%

Section: Plasma Transfusionsmentioning

confidence: 99%

See 1 more Smart Citation

Transfusion management for children supported by extracorporeal membrane oxygenation

Karam

Nellis

2021

Transfusion

View full text Add to dashboard Cite

Ideas • Due to the patients' underlying illness, in combination with circuit-induced coagulopathy, as well as PLT dysfunction, children supported by ECMO are a risk of receiving large volumes of blood components. • Given the increasing use of modified blood products and newer biologics, it is unknown whether these products have equal efficacy and safety, in ECMO. • The majority of guidance for transfusion therapy is based on expert opinion alone, and research on indications for RBC, plasma, and PLT transfusions for children on ECMO should be a priority.

show abstract

“…Thromboelastography (TEG) can also be used to monitor perioperative coagulation function for TEG can substantiate changes in coagulation status produced by hemodilution. TEG measurements have become an accepted measure to assess changes in coagulation after volume replacement [11][12] .…”

Section: Anesthesia and Surgerymentioning

confidence: 99%

Anesthetic Management of a Child From the Qinghai-tibet Plateau With a Double Outlet Right Ventricle and Severe Polycythemia: A Case Report

Tan

Zhang

Zuo

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Acquired secondary polycythemia is common in patients with a double outlet right ventricle, and results from tissue hypoxia. Secondary erythrocytosis can cause coagulation deficiencies, and increases the risks of thrombosis and infarction. Perioperative management in double outlet right ventricle patients with severe erythrocytosis is intractable, and only a few cases have been reported. Case presentation: Herein, we report the anesthetic management of a 10-year-old female patient with a double outlet right ventricle. She lived in the low-oxygen Qinghai−Tibet Plateau, and presented with severe polycythemia (hemoglobin, 24.8 g/dL; hematocrit, 75%). She underwent a modified Fontan surgery, which was satisfactory and without any perioperative complications. Our anesthetic management highlights the importance of perioperative hemodilution to decrease the risk of thromboembolism, and correction of coagulopathy to prevent hemorrhage. Conclusions Anesthetic management is challenging in rare cyanotic congenital heart disease patients with severe polycythemia. For prevention of thrombosis and hemorrhage, it is important to adopt perioperative hemodilution and correction of coagulopathy.

show abstract

Thromboelastography-guided management of coagulopathy in neonates with congenital diaphragmatic hernia supported by extracorporeal membrane oxygenation

Cited by 26 publications

References 12 publications

Hemostatic Testing in Critically Ill Infants and Children

Hemostatic Testing in Critically Ill Infants and Children

Transfusion management for children supported by extracorporeal membrane oxygenation

Anesthetic Management of a Child From the Qinghai-tibet Plateau With a Double Outlet Right Ventricle and Severe Polycythemia: A Case Report

Contact Info

Product

Resources

About